“Subcuticular (Polyglecaprone 3-0) Versus Three Mattress (Polypropylene 3-0) Suture Technique for Skin Closure of Low Transverse Incision in Obg Surgeries”

Abstract

Introduction: The skin act as barrier between internal structures and external environment and is susceptible to injury, either through accidental or planned surgical incision1. Cutaneous wound healing is a necessary physiological process consisting of the combined action of many cell strains and their regenerations2. Wound closure techniques have evolved from early development in suturing materials to advanced resources that include staples, tapes and adhesive compounds3. Suturing, which is a method of wound closure is thousands year old4. Various techniques of wound closure are simple interrupted, mattress, continuous, subcuticular and intradermal. A subcuticular stitch in a Pfannenstiel incision runs along the natural skin lines hence improves and hasten wound healing, it allows early ambulation and fasten recovery. Mattress sutures were outdated for years mostly due to its cosmetic appearance but its resurgence for skin closure is for reducing the cost of therapy and time in tertiary referral centre, indirectly in periphery without affecting the quality of treatment. As the disadvantage of mattress suture technique is that it has high propensity to dig into skin and cause prominent stitch marks therefore in order to this the number of sutures applied has been reduced to three mattress suture in our study. In view of prevailing scenario regarding wound closure, techniques and material used no clear preference of suture material is known therefore present study is planned to compare three mattress and subcuticular techniques of closure and to compare the difference in rate of complications among the two suture material and technique. Aim And Objectives: The aim of this study was to compare the subcuticular suture (Polyglecaprone 3-0) with three mattress suture (3-0 polypropylene) for skin closure of low transverse incision in obstetrics and gynecological surgeries. Materials and method: A prospective randomized trial was conducted in the Department of Obstetrics and Gynecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda from December 2019 onward on 112 women undergoing Caesarean section/Laparotomy by low transverse incision after getting approval from the Scientic, Protocol Review Committee and Ethical Committee of the institution. Group I: Women in which skin closure was done by subcuticular technique using Polyglecaprone 3-0. Approximation of fat layer was done by using plain catgut 2-0. Group II: Women in which skin closure was done by three mattress, that is, one at each corner and one in middle using Polypropylene 3-0 by far-far-near-near technique. In the postoperative period, 48 hours after surgery the patient was assessed for pain by NRS scale and wound condition by looking for erythema, swelling, oozing, infection, haematoma, seroma, pus discharge and fever. On 5th day in Group II (Three mattresss suture technique) sutures were removed and in both the groups wound were assessed again for erythema, swelling, oozing, infection, haematoma, seroma, pus discharge and fever. After 6 weeks patient was again assessed for scar condition according to OSAS scale. Results: After 6 weeks patient was again assessed for scar condition according to OSAS scale. The two groups were comparable with regards to demographic prole. There was no signicant difference in age, residence, socioeconomic status, parity, BMI between the two groups. There was signicant difference in time of skin closure as women in group I (Subcuticular group) took longer time for closure of skin as compared to group II. This difference was statistically highly signicant (P value <0.001). At 48 hours post operative pain score was calculated using NRS scale in both the groups. Mean pain score was more in group I (5.45 +0.85) as compared to group II (3.80 +0.80). Pain was more in women in Group I as compared to Group II. This difference was statistically highly signicant (P value<0.001). At 48 hours post surgery skin wound was also assessed for wound complications like erythema, swelling/induration, seroma, haematoma, pus discharge and oozing. Most of the women in both groups i.e. 42 women in Group II (75%) and 46 women in Group II (82%) had no wound complications. It was observed that local wound complications were slightly more in group I (subcuticular group) as compared to group II (mattress group) but the difference was not statistically signicant (P value>0.05). The expenditure of skin closure in group I was approximately double as compared to group II as the cost of skin closure in group I included skin incision closure with Polyglecaprone 3-0 along with subcutaneous fat closure with Plain catgut 2-0 and group II included only skin closure with Polypropylene 3-0. Conclusion: It was concluded from the present study that skin closure with Subcuticular group versus three mattress suture technique had similar outcomes with respect to wound complications at 48 hours postoperative and 5th day post operative. However skin closure was quick, cost effective with less postoperative pain in three mattress suture technique using Polypropylene 3-0 as compared to subcuticular technique. However wound closure by Subcuticular technique using Polyglecaprone 3-0 yields a cosmetically better scar.