World Journal of Surgery

, Volume 38, Issue 5, pp 1044–1050 | Cite as

Continuous Absorbable Intradermal Sutures Yield Better Cosmetic Results than Nonabsorbable Interrupted Sutures in Open Appendectomy Wounds: A Prospective, Randomized Trial

  • Anne Koskela
  • Sannamari Kotaluoto
  • Ilkka Kaartinen
  • Satu-Liisa Pauniaho
  • Tuomo Rantanen
  • Hannu Kuokkanen



Acute appendicitis is the most common reason for abdominal surgery in young adults and children. Open appendectomy is still the treatment often chosen because it is simple, safe, and effective. Our aim was to study whether cosmetic results of appendectomy wounds are better after using continuous absorbable intradermal (A) sutures compared with wound closure with interrupted nonabsorbable (NA) sutures.


A total of 206 adult patients with clinically suspected appendicitis were allocated to the study and prospectively randomized into two wound-closure groups: the interrupted NA suture group and the A suture group. Of these, 193 patients with sufficient data were invited to the outpatient clinic for cosmetic analysis. Cosmetic results were evaluated after a median of 14 months. For subjective scar assessment, the Vancouver scar scale, the patient and observer scar assessment scale (POSAS), and a visual analog scale (VAS) were used. Objective evaluation was carried out by measuring surface area, average width, and estimated concentration change (ECC) of hemoglobin and melanin in the scar using spectrocutometry. For statistical analyses we used the Mann–Whitney test and Student’s t test.


Both objective and subjective analyses showed better cosmetic results for absorbable intradermal suturing. The difference between the two groups was statistically significant as regards POSAS in both patient (p = 0.032) and observer scales (p = 0.001), and VAS (p = 0.002). Scar surface area was significantly smaller in group A than in group NA (p = 0.002). ECC measurements showed higher values for melanin in group NA than in group A (p = 0.034).


Continuous intradermal absorbable suturing yields a better cosmetic result than interrupted nonabsorbable suturing in lower abdominal transverse appendectomy.


Appendicitis Levobupivacaine Open Appendectomy Suture Group Scar Assessment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank consulting statistician Mika Helminen, Science Center, Pirkanmaa Hospital District, Tampere, Finland, and School of Health Sciences, University of Tampere, Tampere, Finland, and participating investigator Petri Välisuo, Department of Electrical and Energy Engineering, University of Vaasa, Vaasa, Finland.


None of the authors has any financial interests concerning the products mentioned in this article.


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Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Anne Koskela
    • 1
  • Sannamari Kotaluoto
    • 2
    • 6
  • Ilkka Kaartinen
    • 1
  • Satu-Liisa Pauniaho
    • 3
    • 4
  • Tuomo Rantanen
    • 4
    • 5
  • Hannu Kuokkanen
    • 1
  1. 1.Department of Plastic SurgeryTampere University HospitalTampereFinland
  2. 2.Department of Gastroenterology and Alimentary Tract SurgeryTampere University HospitalTampereFinland
  3. 3.Center for Child Health ResearchUniversity of TampereTampereFinland
  4. 4.Central Hospital of SeinäjokiSeinäjokiFinland
  5. 5.Department of SurgeryKuopio University HospitalKuopioFinland
  6. 6.Valkeakoski District HospitalValkeakoskiFinland

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