WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Faris M. Hadi Al-Shamaa*, Omar S. Abdelqader Al-Abassi and Saad Ahmed Ali

ABSTRACT

Aim: To study the advantage and disadvantage of Michel clips and 2 / 0 nylon subcuticular suture for closure of collar incision following thyroid operation. Patients and Method: A prospective cohort study from 1st of October 2010 to 1st of Augest 2011 for 200 patients were admitted to Al- Jumhoori Teaching Hospital and underwent thyroid operations. All the patients had no previous operation in the neck. Their incisions closed by either Michel clips (100 patients 10 of them male) or 2/0 nylon subcuticular suture (100 patients 10 of them male). The two groups were well matched for age, sex, diagnosis, systemic disease, drug history, ASA grade, indication for surgery, incision length, type and duration of operation. The time taken for operations for both groups and the time taken to close the skin were calculated using hand watch. At the end of the operation the length of each wound was measured and recorded to the nearest centimeter. then wound was washed by normal saline 0.9% and closed, application of povidone iodine and dressed by sterile gauze. Follow up for the both groups were done for at least 7 days for postoperative pain, volume of drain, day of removal of drain, surgical site infection, hematoma, day of removal, time taken for removal, and comfortable at removal of Michel clips or subcuticular suture and cosmetic of wound. The postoperative pain and pain at removal were assessed by using verbal response into four options (no pain, mild pain, moderate pain, and severe pain). The cosmetic appearance of each wound was assessed by the surgeon, and the patient. The patient, and the surgeon, were unaware of each other's grading. Verbal response again was used for grading into four options (poor, fair, good, and excellent). Results: The time taken for closure of wound by Michel clips is 60 –120 seconds in 89 patients, and by subcuticular suture is 60 – 120 seconds in 82 patients. Pain at removal of Michel clips is mild in 5, moderate in 87, severe in 8 patients, while for subcuticular suture no pain in 35, mild in 62, moderate in 3 patients. Time taken for removal of Michel clips is 120 –180 seconds in 68 patients, and more than 180 seconds in 32 patients, while for subcuticular suture is less than 10 seconds in all patients. Cosmetic of wound at removal of Michel clips is poor in 35, fair in 52, good in 8, and excellent in 5 patients while for subcuticular suture is poor in 0, fair in 9, good in 30, and excellent in 61 patients. Conclusion: There is no significant difference in the time taken for closure of collar incision by Michel clips or subcuticular suture, Subcuticular suture is less painful, takes shorter time for removal, and more cosmetic at removal, subcuticular suture is more convenient than Michel clips for closure of collar incision following thyroid operation.