Staples Compared With Subcuticular Suture for Skin Closure After Cesarean Delivery

Tuuli, Methodius G.; Rampersad, Roxane; Carbone, J.; Stamilio, David M.; Macones, George A.; Odibo, Anthony O.

doi:10.1097/aog.0b013e31820ad61e

Cited by 99 publications

(38 citation statements)

References 21 publications

(31 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…16 Finally, several studies have examined the role of skin closure with suture compared with staples, with the most recent meta-analyses concluding that skin closure with suture decreases wound morbidity following cesarean. 17, 18 …”

Section: Introductionmentioning

confidence: 99%

Impact of evidence-based interventions on wound complications after cesarean delivery

Temming

Raghuraman

Carter

et al. 2017

American Journal of Obstetrics and Gynecology

Self Cite

View full text Add to dashboard Cite

Background A number of evidence-based interventions have been proposed to reduce post cesarean wound complications. Examples of such interventions include appropriate timing of preoperative antibiotics, appropriate choice of skin antisepsis, closure of the subcutaneous layer if subcutaneous depth is ≥ 2 cm, and subcuticular skin closure with suture rather than staples. However, the collective impact of these measures is unclear. Objective We sought to estimate the impact of a group of evidence-based surgical measures (prophylactic antibiotics administered prior to skin incision, chlorhexidine-alcohol for skin antisepsis, closure of subcutaneous layer, and subcuticular skin closure with suture) on wound complications after cesarean, and to estimate residual risk factors for wound complications. Study Design We conducted a secondary analysis of data from a randomized controlled trial of chlorhexidine-alcohol versus iodine-alcohol for skin antisepsis at cesarean from 2011–2015. The primary outcome for this analysis was a composite of wound complications, including surgical site infection (SSI), cellulitis, seroma, hematoma, and separation within 30 days. Risk of wound complications in women who received all four evidence-based measures (prophylactic antibiotics within 60 minutes of cesarean and prior to skin incision, chlorhexidine-alcohol for skin antisepsis with three minutes of drying time prior to incision, closure of subcutaneous layer if ≥ 2 cm of depth and subcuticular skin closure with suture) were compared to those who did not. We performed logistic regression analysis limited to patients who received all the evidence-based measures to estimate residual risk factors for wound complications and SSI. Results Of 1082 patients with follow-up, 349 (32.3%) received all the evidence-based measures and 733 (67.7%) did not. The risk of wound complications was significantly lower in patients who received all the evidence-based measures compared to those who did not (20.3% vs 28.1%; aRR 0.75, 95% CI 0.58, 0.95). The impact appeared to be largely driven by a reduction in surgical site infections. Among patients who received all the evidence-based measures, unscheduled cesarean was the only significant risk factor for wound complications (27.5% vs. 16.1%, aRR 1.71, 95% CI 1.12, 2.47) and SSI (6.9% vs. 1.6%, RR 3.74, 95% CI 1.18, 11.92). Other risk factors, including obesity, smoking, diabetes, chorioamnionitis, surgical experience, and skin incision type were not significant among patients who received all of the four evidence-based measures. Conclusion Implementation of evidence-based measures significantly reduces wound complications, but the residual risk remains high. This suggests the need for additional interventions, especially in patients undergoing unscheduled cesareans, who are at risk for wound complications even after receiving current evidence-based measures.

show abstract

Section: Introductionmentioning

confidence: 99%

Impact of evidence-based interventions on wound complications after cesarean delivery

Temming

Raghuraman

Carter

et al. 2017

American Journal of Obstetrics and Gynecology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Despite the paucity of clinical trials in gynecology, the obstetric literature demonstrates a decrease in wound complications and improvement in pain and cosmetic result with the use of suture. 10–14 …”

Section: Introductionmentioning

confidence: 99%

Wound Complication Rates After Staples or Suture for Midline Vertical Skin Closure in Obese Women

Kuroki

Mullen

Massad

et al. 2017

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

OBJECTIVE To compare wound complication rates after skin closure with staples versus subcuticular suture in obese gynecology patients undergoing laparotomy through midline vertical incision. METHODS In this randomized controlled trial, women with a body mass index (BMI) ≥ 30 kg/m2 undergoing surgery by a gynecologic oncologist through midline vertical incision were randomized to skin closure with staples or subcuticular 4-0 monofilament suture. The primary outcome was the rate of wound complication, defined as the presence of a wound breakdown, or infection, within eight weeks postoperatively. Secondary outcomes included operative time, Stony Brook scar cometic score, and patient satisfaction. A sample size of 162 was planned to detect a 50% reduction in wound complications. At planned interim review (n=82), there was no significant difference in primary outcome. RESULTS Between 2013 and 2016, 163 women were analyzed, including 84 who received staples and 79 suture. Women who received staples were older (mean age 59 vs. 57 years), had lower mean BMI (37.3 vs 38.9 kg/m2), and fewer benign indications for surgery (22 vs. 27). There were no differences in wound complication rates between staple versus suture skin closure [28 (33%) vs. 25 (32%), relative risk (RR) 1.05, 95% confidence interval (CI) 0.68–1.64]. Women with staples reported worse median cosmetic scores (4/5 vs. 5/5, P<0.001), darker scar color (37 (49%) vs. 13 (18%), RR 2.69, 95%CI 1.57–4.63), and more skin marks [30 (40%) vs. 3 (4%), RR 9.47, 95% CI 3.02–29.65] compared to women with suture closure. There was no group difference regarding satisfaction with their scar. Stepwise multivariate analysis revealed BMI (OR 1.13, 95% CI 1.07–1.20), maximum postoperative glucose (OR 1.01, 95% CI 1.00–1.01), and cigarette smoking (OR 4.96, 95% CI 1.32–18.71) were correlates of wound complication. CONCLUSION Closure of midline vertical skin incisions with subcuticular suture does not reduce surgical site wound complications compared to staples in obese gynecology patients.

show abstract

“…Wound complications are a major cause of morbidity after CS (11). The prevalence of wound infection and dehiscence after CS is reported as 3% to 15%.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Abdominal Binder on Wound Healing and Consumed Pain Medications After Cesarean Section: A Randomized Control Trial

Ghana¹,

Hakimi²,

Mirghafourvand³

et al. 2017

Iran Red Crescent Med J

View full text Add to dashboard Cite

show abstract

Staples Compared With Subcuticular Suture for Skin Closure After Cesarean Delivery

Abstract: Staple closure is faster to perform but associated with a higher risk of wound complications.

Cited by 99 publications

References 21 publications

Impact of evidence-based interventions on wound complications after cesarean delivery

Impact of evidence-based interventions on wound complications after cesarean delivery

Wound Complication Rates After Staples or Suture for Midline Vertical Skin Closure in Obese Women

The Effects of Abdominal Binder on Wound Healing and Consumed Pain Medications After Cesarean Section: A Randomized Control Trial

Contact Info

Product

Resources

About