Comparison of the effect of skin closure materials on skin closure during cesarean delivery

Abstract

Objective To compare the effect of skin closure materials on skin closure during cesarean delivery. Methods We searched EMBASE、PubMed、Scopus、Cochrane CENTRAL for randomized controlled trials (RCTs) on the use of closure materials for skin closing effect during cesarean delivery. The outcomes were time to skin closure of dermal and epidermal layer, skin separation rate and wound complications(wound infection, hematoma,seroma, reclosure, readmission) reported as an odds ratio (OR) and surface under the cumulative ranking curve analysis (SUCRA) score. Results Twenty -six RCTs met the inclusion criteria. In the network meta-analysis (NMA) for time to skin closure of dermal and epidermal layer, pooled network OR values indicated that staple (network SMD, -337.50; 95% CrI: -416.99 to -263.18) was superior to absorbable suture. In the Skin separation NMA, pooled network OR values indicated that the absorbable suture (network OR, 0.37; 95% CrI: 0.19 to 0.70) were superior to staple. In the wound complications NMA, pooled network OR values indicated that the no interventions were superior to staple. Conclusion In conclusion, our network meta-analysis showed that the risk of skin separation with absorbable suture after cesarean delivery was reduced compared with staple, and does not increase the risk of wound complications, but the wound closure time would slightly prolonged.

Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews

“…The overview includes 38 SRs 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 (16 Cochrane and 22 non-Cochrane) published between 2004–2024 involving 628 RCTs with a total of 190,349 participants. Table 1 summarises the main characteristics of the included SRs (see Annex 4 for details).…”

“…RTC/No. participants) Certainty of evidence Category Technique s and materials Fascia and muscle layers closure Subcutaneous closure 58 , 59 Subcutaneous tissue closure Non-closure Seroma formation 0.53 [0.33, 0.84] (8/1979) High Any type of wound complications 0.66 [0.47, 0.93] (10/3811) High Wound infection 1.02 [0.69, 1.50] (5/1348) Moderate Endometritis 0.77 [0.46, 1.28] (1/590) Moderate Blood loss (mL) 9.00 [−24.29, 42.29] (1/590) Moderate Haematoma formation 0.74 [0.22, 2.42] (7/1663) Moderate Duration of surgery (min) 0.60 [−2.29, 3.49] (1/590) Moderate Skin closure 60 , 61 , 62 , 63 , 64 Subcuticular PGA absorbable suture Interrupted nylon suture Hypertrophic scar at 6 months 1.85 [1.33, 2.58] (1/65) Low Subcuticular barbed suture Subcuticular PDS suture Wound infection 0.96 [0.18, 5.10] (1/188) Low Wound complication 1.44 [0.30, 6.93] (1/188) Low Time skin closure (min) 0.60 [−0.30, 1.50] (1/188) Low Conventional sutures Combined postoperative morbidity 0.88 [0.46, 1.65] (1/188) Very Low …”