A Randomized Trial to Compare Purse-string Suture With Occlusive Absorbent Dressing for the Closure of Tube Thoracostomy Incision at the Kenyatta National Hospital.

Abstract

Tube thoracostomy incision has been closed in various ways. The purse-string closure has been the norm for the closure of the incision. New methods have been developed over time to address the shortcomings of the purse-string method. These methods include the use of absorbable sutures, staples, and occlusive absorbent dressings. Without a consensus on the closure method, this study compared the outcomes of two methods and provided scientific data to guide on best practice for the closure of the incision. Objective To compare purse-string suture with occlusive absorbent dressing for the closure of tube thoracostomy incision. Methods We randomized chest trauma patients at Kenyatta National Hospital who required tube thoracostomy incision into a dressing arm and suture arm. The rates of complications, pain scores and scar scores for incision closure using a dressing and purse-string method were compared. The overall outcome was to establish a non – inferiority comparison for dressing method to purse-string in order to promote its utilization in closure of chest tube incisions. Results From September 2021 till March 2022, 81 participants were enrolled into the study, of which 40 (49.4%) and 41 (50.6%) were randomized to the dressing and suture arms respectively. All of whom were included in the analysis. There were 55 (67.9%) males and 26 (32.1%) females, where the overall mean age was 35.8±13.9 years, of which the minimum observed age was 18.0 years and maximum was 67.0 years old. The mean age for dressing arm was XIII

36.8±13.4 and 34.9±14.5 for the suture arm. Twenty-five (30.9%) patients had blunt chest trauma while 56 (69.1%) patients had penetrating chest trauma. Of the 25 patients, 14 (35.0%) were randomized into the dressing arm while 11 (26.8%) into the suture arm. Of the 56 patients, 26 (65%) were randomized into the dressing arm, while 30 (73.2%) into the suture arm. For the dressing arm, 32 (80%) had Haemothorax, while 11 (27.5%) had pneumothorax. For the suture arm, 25 (61%) had Haemothorax while 23 (56.1%) had pneumothorax. Overall pain scores were significantly less in the dressing arm. Median (IQR)2.0 (2.0 – 4.0) vs 8.0 (4.0 – 8.0) (P<0.001), Mean Rank 20.5 vs 61.0(P<0.001). Mean ± SD 3.0±1.8 vs 6.3±2.8 (P<0.001) Overall Cosmesis was significantly better in the dressing arm. Scar scores Mean ± SD 3.3±1.0 vs 11.3±1.4 (P<0.001), Median (IQR) 3.0 (3.0 – 4.0) vs 11.0 (11.0 – 12.0) (P<0.001), Mean Rank 20.50 vs 61.00 (P<0.001). There was no difference in the rates of SSI, recurrent acute and late pneumothoraces, and persistent drainage between the two arms. Conclusions Dressing method for closure of tube thoracostomy incision proved to have less pain and better Cosmesis outcomes with no difference in the complications rates.