Vigorous Wound Irrigation Followed by Subcuticular Skin Closure in Children with Perforated Appendicitis
Paiboon Sookpotarom MD*,**, Wasana Khampiwmar MD*, Tanapron Termwattanaphakdee MD*
Affiliation : * Department of Surgery, Buddhachinaraj Hospital, Naresuan University, Phitsanulok, Thailand ** Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
Background : Although various protocols for the treatment of children with perforated appendicitis have been
established, no one has cited incisional wound irrigation in detail.
Material and Method: The records of 69 children undergoing appendectomy for perforated appendicitis
between 2004 and 2006 were reviewed. Wound irrigation prior to skin closure using 1-2 liters of normal
saline was routinely performed in every case. The treatment protocol includes preoperative and postoperative
antibiotic, early appendectomy, copious intraabdominal swab, vigorous wound irrigation and subcuticular
skin closure. Either peritoneal lavage or transperitoneal drainage is omitted.
Results : Mean patients’ age was 8.7 years, 47.8% were girls and there was no death. Subcutaneous fat
thickness averaged 1.3 cm. Mean duration of hospitalization was 5.8 days. Of 69 appendectomies, 47 had
simple perforation and 22 developed complicated perforation. There were four post-op complications (5.8%).
Two patients had very small seroma at the lateral margin of incision, which resolved without additional
treatment. One boy developed adhesion obstruction and enterocutaneous fistula, postoperatively. The patient
required reoperation and recovered uneventfully. Only one child had wound infection.
Conclusion : Vigorous wound irrigation followed by subcuticular skin closure for perforated appendicitis
yields an acceptable outcome with low rate of wound complications.
Keywords : Perforated appendicitis, Wound irrigation, Wound infection
