Abstract
Except through natural orifices, all surgical operations involve making skin incisions which are often closed with suture materials to which the skin may react. This is a five-year (2005-2009) retrospective study of postoperative outcomes of 998 clean skin incisions closed with continuous subcuticular suture materials in 796 children at two Nigerian centres. The children were aged between 1 day and 18 years (mean 6.5 ± 3.4 years) with a male to female ratio of 2.5:1. The location of the incisions ranged from groin in 678 (67.9%) cases to lower limbs in 15 (1.5%), these were associated with 414 (61.1%) and 13 (86.7%) postoperative complications respectively. Sutures were not removed from the skin in 734 cases and were associated with 558 (76%) postoperative complications whereas sutures were removed between 5-7 postoperative days in 264 cases and were associated with 39 (14.8%) postoperative complications (P<0.0001). Whereas postoperative wound infection in 69 (6.9%) cases occurred before ten days, stitch abscess/sinus, 156 (15.6%), suture extrusion, 80 (8%), hyperpigmentation, 211 (21.1%), pruritus, 182 (18.2%), hypertrophied scars, 128 (12.8%), and keloid formation, 9 (0.9%), occurred after the tenth postoperative day among those whose sutures were not removed in direct proportion to patients’ age/suture size. These postoperative complications gave rise to 343 (34.3%) good, 245 (24.5%) fair, and 9 (0.9%) poor cosmetic outcomes, whereas 401 (40.2%) incisions without postoperative complication gave excellent cosmetic outcomes. It is suggested from this study that continuous subcuticular suture materials which should be removed not later than the tenth postoperative day be used for skin closure in
children.
Keywords: Pediatric, skin closure, suture materials, outcome
Résumé
A l’exception des orifices naturels, toutes les chirurgies impliquant les incisions de la peau sont souvent fermées avec les matériaux de suture dont la peau pourrait réagir. Cette étude rétrospective de cinq ans (2005- 2009) examinait 998 incisions chirurgicales sur la peau après l’opération de 786 enfants dans deux centres des soins au Nigeria. Les enfants étaient âgés entre un jour à 18 ans (moyenne d’âge 6.5 ± 3.4 ans) avec une proportion male et femelle de 2.5:1. Le lieu des incisions variaient du groin chez 678 (67.9%) cas aux membres inferieures chez 15 (1.5%) cas. Ceux-ci étaient associés avec les 414 (61.1%) et 13 (86.7%) complications post chirurgies respectivement. Les sutures n’étaient pas enlevées de la peau chez 734 cas et étaient associée avec 558 (76%) complications post chirurgies alors que les sutures étaient enlevées entre 5-7 jours chez 264 cas post chirurgicale et étaient associées avec 39 (14.8%) de complications (P<0.0001). Cependant l’infection des blessures post chirurgicales chez 69 (6.9%) cas a eu lieu avant le dixième jour, les abcès du à la suture/sinus, 156 (15.6%), suture d’extrusion, 80 (8%), hyperpigmentation, 211 (21.1%), démangeaisons, 182 (18.2%), cicatrices hypertrophiées, 128 (12.8%), et la formation des keloides, 9 (0.9%), apparus après le dixième jour post chirurgicale chez ceux dont les sutures n étaient pas enlevées en proportion direct de l’âge du patient et de la taille de la suture. Ces complications post chirurgies induisaient des résultats cosmétiques variés: chez 343 (34.3%) bien, 245 (24.5%) moyen, et 9 (0.9%) faible alors que 401 (40.2%) des incisions sans complications post chirurgicales donnaient des résultats cosmétiques excellents. Il a été recommandé que l’usage continue des
matériaux de sutures ne doit pas rester pour plus de dix jours post chirurgicale soit utilisé pour la suture la peau des enfants.
Correspondence: Dr. O.D. Osifo, Paediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria. E-mail: leadekso@yahoo.com
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