Closure of Pfannenstiel skin incisions in cesarean sections: comparison of wound outcomes with interrupted mattress vs. subcuticular suture

Choudhary, Anjali; Bansal, Neeta; Chaudhari, Priyanka

doi:10.18203/2320-1770.ijrcog20172917

Cited by 5 publications

(8 citation statements)

References 9 publications

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“…Women were discharged earlier since there was no need for suture removal. 16 SSI was more common in women in whom surgery duration was more. In group I, mean duration of surgery was 1.45±0.23 hours and 1.02±0.21 hours in group II which was found to be statistically significant (p <0.05).…”

Section: Discussionmentioning

confidence: 95%

Assessment of risk factors for surgical site infection following caesarean section

Sangwan

Malhotra

2019

Int J Reprod Contracept Obstet Gynecol

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Background: Assessment of surgical site infection is an important factor to determine the functioning of the health care system. Objectives of this study was to estimate the incidence of surgical site infection among caesarean section cases and to determine the risk factors associated with surgical site infection and comparison with patients having healthy wounds.Methods: One thousand pregnant women who underwent caesarean section were divided into two groups: Group 1 (cases): Those who had SSI within 30 days of caesarean section and Group 2 (controls): Those who didn’t have SSI.Results: Mean age of group I was 25.35±4.40 and 21.12±3.60 years in group II (p >0.05). Mean gestational age of group I cases was 38.07±1.88 weeks and in group II, it was 38.17±2.06 weeks (p >0.05). A total of 37 (82.5%) women in group I and 931 (96.98%) women in group II underwent emergency caesarean section (p <0.05). In group I, mean duration of surgery was 1.0±0.13 hours and 1.02±0.21 hours in group II (p <0.05). Maximum number of patients i.e. 22 (55%) had wound discharge between 4-7 days followed by 11 (27.5%) between 8-10 days. Mean wound discharge was 7.32±3.45 days in group I. Majority of women, i.e. 27 (67%) found to be sterile in the present study followed by 7 (17.5%) women were found to have staphylococcus aureus. Mean duration of resuturing was 17.42±6.98 days. Mean baby weight in group I was 2.72±0.53 kg and in group II it was 2.95±0.53 kg (p <0.001).Conclusions: Risk of developing SSI after caesarean section is multi-factorial and found to be influenced by emergency surgery, PROM, pre-operative anaemia, multiple vaginal examinations, interrupted skin suturing, raised BMI, nulliparity, emergency caesarean, duration of surgery.

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Section: Discussionmentioning

confidence: 95%

Assessment of risk factors for surgical site infection following caesarean section

Sangwan

Malhotra

2019

Int J Reprod Contracept Obstet Gynecol

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“…Our study found that occurrence of wound complications in interrupted group more than in the subcuticular group. Choudhary A, et al has reported that subcuticular absorbable material offered better skin approximation and healing than interrupted suture which needed re-suturing more often (7). Makeen, et al in their systematic review of Cochrane database on techniques and material for closure of caesarean section found that non absorbable staples were associated with increased risk of separation and resuturing than absorbable subcuticular suturing (6).…”

Section: Discussionmentioning

confidence: 99%

“…Time taken for skin closure was less and approximation was better without tension. Women were discharged earlier since there was no need for suture removal (7).…”

Section: Discussionmentioning

confidence: 99%

Skin closure with Pfannenstiel incision in lower segment caesarean section; comparison of wound outcome with interrupted vs. subcuticular techniques

et al. 2020

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Introduction:Caesarean section is the most common surgical procedure performed in the world. A vast majority of the procedures are carried out with Pfannenstiel incision. Different techniques and materials are used to approximate the skin in caesarean section. Each method has its own advantages and disadvantages. The objective of the study was to compare surgical wound outcome and satisfaction of women who underwent Pfannenstiel incision closure with interrupted vs. subcuticular suturing in caesarean sections. Methods:A prospective comparison was carried out in 400 age and body mass index matched women who underwent lower segment caesarean section for the first time. Standard lower segment caesarean section was performed with assigning interrupted and subcuticular wound closure for 200 women in each group, following matching for BMI and age. Two arms were compared for wound complications, postoperative pain and overall satisfaction of the outcome. Results:There was no statistically significant difference between groups for baseline characteristics (age, BMI and category of caesarean sections). According to visual analogue scale 91% of women reported to have moderate to severe pain in interrupted group compared to 80% in subcuticular group (p<0.05). Wound complications were present in 8% of interrupted group vs 3% in subcuticular group (p<0.001). Sixty four percent of women were satisfied with subcuticular method vs. 28% with interrupted method (p<0.001). Conclusions:Women who had subcuticular suturing method had less post-operative pain, better wound outcome and more satisfaction compared to interrupted suturing.

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“…7 Many techniques and suture materials have been tried to achieve closure and restore the structural and functional anatomy of skin. 8 The methods for skin closure at caesarean section include subcuticular sutures with absorbable and nonabsorbable suture materials, interrupted mattress sutures, metal staples, absorbable staples, adhesive closure strips and tissue adhesives. 9 An ideal wound closure device or technique should be easy to use, fast, painless, should provide excellent cosmetic appearance and be cost effective; no wound closure technique is ideal for all situations and the physician decides which method suits that particular patient.…”

mentioning

confidence: 99%

“…Vertical mattress suture involves piercing the skin at four points at the same level for a single stitch, gathers a good amount of subcuticular tissue and fat in a tight stitch and leaves gaps between the sutures to allow drainage of blood and serosanguineous discharge from fat necrosis. 8 Mattress sutures obliterates the dead space and provides increased wound strength but disadvantages include difficulty in approximating wound edges and prominent suture marks leading to thick scars. 14 This study was aimed to compare the wound outcomes in two widely used skin closure techniques -subcuticular sutures and mattress sutures for Pfannensteil incision closure in caesarean section.…”

mentioning

confidence: 99%

Which is better for pfannensteil skin incision closure in caesarean section? Interrupted mattress suture or continuous subcuticular suture

Bhovi

Prabhudeva

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: Caesarean delivery is one of the most commonly performed operations in obstetrics. Postoperative comfort of the woman largely depends on the method of skin closure. Wound complications from caesarean delivery such as dehiscence or infection cause a significant emotional and economic burden in obstetric care. There are many methods and techniques for skin wound closure in caesarean section. Each technique has its own advantages and disadvantages. The aim and objective of this study was to compare the wound outcomes in Pfannensteil incisions closed with mattress sutures using nonabsorbable suture and subcuticular sutures using absorbable sutures in caesarean deliveries.Methods: It is a prospective observational study done on 216 consecutive pregnant women who were admitted to labor room for elective or emergency caesarean section. Patients undergoing caesarean section with Pfannensteil incision between February 2019 to October 2019 were included in this study. Among 216 women, 108 women had mattress sutures and 108 women had subcuticular sutures for skin wound closure. The primary outcome studied was wound complications including erythema, wound dehiscence, burst abdomen, infection and pain which was studied on postoperative day 3-7. The secondary outcome was assessed at 6 weeks follow-up in terms of pain, cosmetic appearance of scar and patient satisfaction about scar.Results: A total of 216 pregnant women undergoing caesarean section were studied who had similar baseline characteristics and risk factors. However, women with previous caesarean section were more in mattress group. The overall incidence of erythema, surgical site infection, wound dehiscence, resuturing and pain was more in mattress group and was statistically significant. During follow-up at 6 weeks, women with subcuticular sutures had cosmetically better scar and more satisfied with their scars than women with mattress sutures but the pain level was same in both groups.Conclusions: Authors conclude that compared to mattress sutures, subcuticular sutures cause significantly fewer wound complications and pain in postoperative period. Also, subcuticular sutures are associated with cosmetically appealing scars and higher patient satisfaction. But there was no difference in pain level at 6 weeks in both methods of skin closure.

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Closure of Pfannenstiel skin incisions in cesarean sections: comparison of wound outcomes with interrupted mattress vs. subcuticular suture

Cited by 5 publications

References 9 publications

Assessment of risk factors for surgical site infection following caesarean section

Assessment of risk factors for surgical site infection following caesarean section

Skin closure with Pfannenstiel incision in lower segment caesarean section; comparison of wound outcome with interrupted vs. subcuticular techniques

Which is better for pfannensteil skin incision closure in caesarean section? Interrupted mattress suture or continuous subcuticular suture

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