Subcutaneous stitch closure versus subcutaneous drain to prevent wound disruption after cesarean delivery: A randomized clinical trial

Magann, Everett F.; Chauhan, Suneet P.; Rodts-Palenik, Sheryl; Bufkin, Laura; Martin, James N.; Morrison, John C.

doi:10.1067/mob.2002.123823

Cited by 86 publications

(55 citation statements)

References 9 publications

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“…13 Suggested mechanisms of preventive action of subcutaneous drains are removing fluids and components in these fluids, reducing dead space of a subcutaneous wound area and helping keep the incision edges together. However, some studies have found that subcutaneous drains do not reduce the incidence of SSI, 16,17 and we also showed that the incisional SSI rate in patients with thick subcutaneous fat tissue was significantly reduced only in high-risk cases. These findings imply the possibility that subcutaneous drains would be useful for high-risk patients, but not for all patients undergoing colorectal surgery.…”

Section: Discussionmentioning

confidence: 67%

“…13 However, findings regarding the utility of subcutaneous drains in the prevention of incisional SSI remain controversial, and some studies have found that subcutaneous drains do not reduce the incidence of SSI. [14][15][16][17] Our previous study also showed the possibility that subcutaneous drains would be useful only for patients with a high risk for incisional SSI and those with thick subcutaneous fat tissue, but not for all patients undergoing colorectal surgery. 13 A possible reason is that subcutaneous drain appears to be unnecessary or rather harmful in patients without thick subcutaneous fat tissue, since the drain is a foreign substance for the human body.…”

Section: S Urgical Site Infection (Ssi) Including Wound Infection (Imentioning

confidence: 99%

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Novel Method of Surgical Incision Management in Patients Undergoing Colorectal Surgery

Fujii

Morita

Sutoh

et al. 2016

International Surgery

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We previously demonstrated that subcutaneous drain is effective for preventing incisional surgical site infection (SSI) in patients with thick subcutaneous fat in colorectal surgery. We have recently attempted a novel closure technique in colorectal surgery for the prevention of incisional SSI. In the current study, we described this novel method for prevention of incisional SSI and share our assessment of efficiency of this incision management in patients undergoing colorectal surgery. The procedure ''wound dressing with temporary negative pressure'' using Opsite Post-Op Visible and an Atom Multipurpose Tube, is a simple and easy method. Immediately after incisions were closed, Opsite Post-Op Visible dressing was applied over the incision site with an Atom Multipurpose catheter, and negative pressure was applied through the catheter. We analyzed the cases of 203 patients who underwent colorectal resection. In 60 cases, we performed this negative pressure system for prevention of SSI. We reviewed the clinical features of these cases treated by this novel method and found that the incisional SSI rate in patients who underwent colorectal resection was significantly reduced following the use of the new method. There were no complications in any of the cases due to DNP. This dressing with negative pressure (DNP) may lead to wound drainage and a reduction of dead space in a subcutaneous wound area. These findings indicate that the use of DNP is safe, easy, and effective for preventing incisional SSI in patients undergoing colorectal surgery. Obesity has been identified as a risk factor for infections and wound complications after a wide variety of surgical procedures. 7,8 We previously demonstrated that the risk of incisional SSI increases with obesity, and that the most useful predictor of incisional SSI is the thickness of subcutaneous fat (TSF), as evaluated by preoperative computed tomography (CT). 12 We also demonstrated that subcutaneous drain is effective for preventing incisional SSI in patients with thick subcutaneous fat in colorectal surgery.13 Subcutaneous drains are effective for wound drainage and reduce dead space in a subcutaneous wound area, which is considered to lead to a reduced risk of incisional SSI. 13 However, findings regarding the utility of subcutaneous drains in the prevention of incisional SSI remain controversial, and some studies have found that subcutaneous drains do not reduce the incidence of SSI.14-17 Our previous study also showed the possibility that subcutaneous drains would be useful only for patients with a high risk for incisional SSI and those with thick subcutaneous fat tissue, but not for all patients undergoing colorectal surgery.13 A possible reason is that subcutaneous drain appears to be unnecessary or rather harmful in patients without thick subcutaneous fat tissue, since the drain is a foreign substance for the human body. Thus, we have recently attempted a novel closure technique in surgery for colorectal surgery for the prevention of incisional SSI. The procedure, w...

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Section: Discussionmentioning

confidence: 67%

Section: S Urgical Site Infection (Ssi) Including Wound Infection (Imentioning

confidence: 99%

Novel Method of Surgical Incision Management in Patients Undergoing Colorectal Surgery

Fujii

Morita

Sutoh

et al. 2016

International Surgery

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“…Although patients who required prophylaxis for Group B Streptococcus or bacterial endocarditis and those diagnosed with chorioamnionitis received an antibiotic preoperatively, all others received parenteral antibiotics upon umbilical cord clamping. No differences in the incidence of ''wound disruption'' (defined as ''a hematoma, seroma, or infection that required the incision to be opened, evacuated, or irrigated and debrided'' [53]) occurred among groups, whether each complication was analyzed individually or collectively.…”

Section: Obstetrics and Gynecologymentioning

confidence: 99%

“…Magann et al [53] examined the effect of subcutaneous (i.e., multi-layer) sutured wound closure vs. subcutaneous drain placement on outcomes following cesarean section. Patients with ‡ 2 cm subcutaneous fat undergoing non-emergent cesarean section were randomized preoperatively to receive either simple skin closure only (n = 205), closure of the subcutaneous tissues with a continuous absorbable suture (n = 191), or a subcutaneous 7 mm Jackson-Pratt CSD (n = 194).…”

Section: Obstetrics and Gynecologymentioning

confidence: 99%

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

Reiffel

Barie

Spector

2013

Surgical Infections

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Background: Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth. Methods: The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed. Results: Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine postoperative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement. Conclusions: Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to ''cover'' an indwelling drain.

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“…Wound infection, which is associated with hematoma, serous secretions and dehiscence, is among the most common causes of post-CS deaths. Such an infection also causes frequent hospitalizations or medical visits for wound debridement, secretion drainage and wound care, which in turn increase healthcare costs (17). Besides, delayed healing of CS surgical wound can affect mother-child relationships, cause anxiety, discomfort, stress and dissatisfaction for mothers, and impose heavy financial and emotional burdens on mothers and communities (8).…”

Section: Introductionmentioning

confidence: 99%

The Effects of Grape Seed Extract Ointment on Approximation of Cesarean Section Wound

et al. 2016

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Background: Cesarean section is among the most important gynecological surgeries and is the most common surgery in the present era. Delayed wound healing is among the main post-cesarean complications. It dramatically affects female's quality of life and causes frequent medical visits and even re-hospitalization. Objectives: This study aimed at investigating the effects of grape seed extract on the approximation of cesarean section wound. Methods: This double-blind randomized controlled trial was done during year 2015 on a convenient sample of 129 eligible females, who had undergone a cesarean section at Valiasr hospital, Birjand, Iran. The candidates were randomly allocated to a placebo and two experimental groups. In one experimental group, the participants were treated with 2.5% grape seed extract ointment (group A) while in the other, 5% ointment was used (group B). Wound approximation was measured by using the redness, edema, ecchymosis, discharge, approximation (REEDA) scale at three time points including before ointment application (T1) as well as at the sixth (T2) and the fourteenth (T3) post-intervention days. The data were analyzed via the SPSS (v. 19.0) software and through analysis of variance, Chi-square, Fisher's exact, Friedman's, Wilcoxon, Kruskal-Wallis and Mann-Whitney U tests, at a significance level of 0.05. Results: Before the study intervention, the difference among the groups regarding the mean score of wound approximation was not statistically significant (P = 0.14). However, there were significant differences among the groups regarding the mean score of wound approximation at T2 (P = 0.002) and T3 (P = 0.02). Conclusions:The findings of this study demonstrate the effectiveness of grape seed extract ointment in accelerating cesarean wound closure. Therefore, the ointment can be used to accelerate wound healing after cesarean section.

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Subcutaneous stitch closure versus subcutaneous drain to prevent wound disruption after cesarean delivery: A randomized clinical trial

Cited by 86 publications

References 9 publications

Novel Method of Surgical Incision Management in Patients Undergoing Colorectal Surgery

Novel Method of Surgical Incision Management in Patients Undergoing Colorectal Surgery

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

The Effects of Grape Seed Extract Ointment on Approximation of Cesarean Section Wound

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