Techniques and materials for skin closure in caesarean section

Mackeen, A. Dhanya; Berghella, Vincenzo; Larsen, Mie-Louise

doi:10.1002/14651858.cd003577.pub3

Cited by 44 publications

(50 citation statements)

References 28 publications

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“…Clay et al reported similar rates that favored suture 50/385 (13.0%) vs. 28/492 (5.7%; pooled OR, 2.11; 95% CI 1.29–3.48). The Cochrane review 21 including these same studies concluded that there is “no conclusive evidence about how the skin should be closed after cesarean section.”…”

Section: Discussionmentioning

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

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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.

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Section: Discussionmentioning

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

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“…3,4 At the end of the operation, the skin incision is typically closed with the placement of either a continuous subcutaneous suture that dissolves over time or multiple metal staples that are removed at a later date. 3,[5][6][7] Our objective was to evaluate whether the wound complication rates after cesarean delivery differ between women whose skin incisions are closed with suture as compared with staples. 3,[5][6][7] Our objective was to evaluate whether the wound complication rates after cesarean delivery differ between women whose skin incisions are closed with suture as compared with staples.…”

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confidence: 99%

Suture Compared With Staple Skin Closure After Cesarean Delivery

Mackeen

Khalifeh

Fleisher

et al. 2014

Obstetrics &Amp; Gynecology

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120

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“…1 Although as many as 1.3 million women undergo this surgery annually in the United States, 2 guidance regarding best practices for skin closure is limited. 3 Generally, a cesarean delivery is performed through a suprapubic low transverse skin incision. At the end of the operation, the skin incision is typically closed with the placement of either a continuous absorbable suture or interrupted staples that are removed at a later date.…”

Section: Methodsmentioning

confidence: 99%