Royal Sussex County Hospital, Brighton, UK.
Russells Hall Hospital, Dudley, UK.
Br J Surg. 2021 Aug 19;108(8):898-907. doi: 10.1093/bjs/znab251.
The aim of this review was to analyse RCTs comparing wound-related outcomes between continuous subcuticular and interrupted transdermal wound closures for open appendicectomies in all age groups.
A systematic literature search was conducted in April 2020 (MEDLINE, Embase, CENTRAL, Web of Science, PROSPERO, Google Scholar, WHO International Clinical Trials Registry Platform). RCTs without restrictions on study language, year, status of publication, and patient age were included. The risk of bias was assessed using the risk-of-bias tool for RCTs. Pooled risk ratios (RRs) and mean differences (MDs) for binary and continuous variables were calculated using random-effects models. A summary-of-findings table was generated to assess the level of evidence.
Eleven trials were included (1781 patients analysed, 891 in continuous and 890 in interrupted groups). The overall rate of wound infection was 7.1 per cent. There was no significant difference in the risk of wound infection (11 trials, 1781 patients; RR 1.13, 95 per cent c.i. 0.77 to 1.66; P = 0.530) or wound exploration (7 trials, 1129 patients; RR 0.74, 0.41 to 1.34, P = 0.320) between the two groups. Continuous wound closure had a significantly reduced risk of wound dehiscence (6 trials, 865 patients; RR 0.16, 0.05 to 0.50; P = 0.002) and smaller wound scar (3 trials, 417 patients; MD -2.11 (95 per cent c.i. -2.57 to -1.66) mm; P < 0.001). The absolute risk reduction and number needed to treat for wound dehiscence were 6.1 per cent and 16 respectively. There was no significant statistical heterogeneity for all outcomes (I2 0-15 per cent, χ2 P > 0.100). Most RCTs had a high risk of bias.
Continuous subcuticular open appendicectomy wound closure is not associated with an increased risk of wound infection and exploration. This method of closure has a reduced risk of wound dehiscence and better cosmetic outcomes.
本综述旨在分析比较连续皮内和间断皮外切口闭合在所有年龄段的开放式阑尾切除术的伤口相关结局的 RCT。
我们于 2020 年 4 月进行了系统文献检索（MEDLINE、Embase、CENTRAL、Web of Science、PROSPERO、Google Scholar、世界卫生组织国际临床试验注册平台）。纳入了不限制研究语言、年份、发表状态和患者年龄的 RCT。使用 RCT 偏倚风险评估工具评估偏倚风险。使用随机效应模型计算二分类变量和连续变量的汇总比值比（RR）和均数差（MD）。生成总结发现表以评估证据水平。
纳入了 11 项试验（分析了 1781 名患者，连续组 891 名，间断组 890 名）。伤口感染总发生率为 7.1%。两组间伤口感染（11 项试验，1781 名患者；RR 1.13，95%置信区间 0.77 至 1.66；P=0.530）或伤口探查（7 项试验，1129 名患者；RR 0.74，0.41 至 1.34，P=0.320）的风险无显著差异。连续伤口闭合的伤口裂开风险显著降低（6 项试验，865 名患者；RR 0.16，0.05 至 0.50；P=0.002），伤口疤痕更小（3 项试验，417 名患者；MD-2.11（95%置信区间-2.57 至-1.66）mm；P<0.001）。伤口裂开的绝对风险降低和需要治疗的人数分别为 6.1%和 16。所有结局的异质性均无统计学意义（I2 0-15%，χ2 P>0.100）。大多数 RCT 的偏倚风险较高。
连续皮内开放式阑尾切除术伤口闭合与伤口感染和探查的风险增加无关。这种闭合方法的伤口裂开风险较低，美容效果更好。
