Interrupted Versus Subcuticular Skin Closure in Pediatric Complicated Appendicitis: A Comparative Study

Muhammad Aslam; Shahnab Ahmad; Rafiq Ahmad Kamran; Syed Tasadak Mehdi; Irum Uzma Khalid; Usama Ali; Amir Hanif; Muhammad Kashif

doi:10.54112/bcsrj.v7i4.2224

Authors

Muhammad Aslam Department of Pediatric Surgery, Nishtar Medical University, Multan, Punjab, Pakistan
Shahnab Ahmad Department of Pediatric Surgery, Children Hospital & Institute of Child Health, Multan, Punjab, Pakistan
Rafiq Ahmad Kamran Department of Pediatric Surgery, DG Khan Medical College, DG Khan, Punjab, Pakistan
Syed Tasadak Mehdi Department of Pediatric Surgery, Children Hospital & Institute of Child Health, Multan, Punjab, Pakistan
Irum Uzma Khalid Department of Pediatric Surgery, Tertiary Care Hospital Nishtar II, Multan, Punjab, Pakistan
Usama Ali Department of Pediatric Surgery, Children Hospital & Institute of Child Health, Multan, Punjab, Pakistan
Amir Hanif Department of Pediatric Surgery, Children Hospital & Institute of Child Health, Multan, Punjab, Pakistan
Muhammad Kashif Department of Pediatric Surgery, Children Hospital & Institute of Child Health, Multan, Punjab, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v7i4.2224

Keywords:

Appendicitis; Appendectomy; Child; Surgical Wound Infection; Sutures

Abstract

Complicated appendicitis in children is associated with a high risk of postoperative wound complications, particularly surgical site infection (SSI). In low- and middle-income countries, open appendectomy remains commonly practiced, making the choice of skin closure technique clinically important. Evidence comparing interrupted and subcuticular skin closure in pediatric complicated appendicitis remains limited. Objective: To compare interrupted versus subcuticular skin closure techniques in terms of surgical site infection following open appendectomy for complicated appendicitis in pediatric patients. Methods: This retrospective comparative study was conducted in the Department of Paediatric Surgery, The Children’s Hospital and Institute of Child Health, Multan, Pakistan, from January 2025 to December 2025, with follow-up until postoperative day 30. Children aged 4–14 years who underwent open appendectomy for complicated appendicitis were included. Patients were allocated to two groups based on the documented skin closure technique: interrupted closure (Group I) and subcuticular closure (Group II). The primary outcome was SSI, assessed on postoperative days 3, 7, 14, and 30 using the Southampton Wound Grading System. Data were analyzed in SPSS version 25.0, and a p-value of ≤0.05 was considered statistically significant. Results: A total of 187 children were included, with 92 in the interrupted closure group and 95 in the subcuticular closure group. The overall mean age was 8.74 ± 3.25 years, and 63.6% were male. No significant difference was observed between groups in age (p=0.733) or gender distribution (p=0.556). SSI rates were comparable between groups at all follow-up points: day 3, 4.3% versus 6.3% (p=0.747); day 7, 8.7% versus 7.4% (p=0.793); day 14, 5.4% versus 3.2% (p=0.492); and day 30, 2.2% versus 1.1% (p=0.617) for interrupted and subcuticular closure, respectively. By postoperative day 30, 98.9% of patients demonstrated Southampton Grade 0 wound healing. Conclusion: Interrupted and subcuticular skin closure techniques showed comparable SSI rates and similarly favorable short-term wound healing outcomes after open appendectomy for complicated appendicitis in children. Subcuticular closure may be considered a reasonable alternative in appropriately selected pediatric patients.

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