Comparison of suture material and technique of closure of subcutaneous fat and skin in caesarean section

Abstract

Background:A large number of women undergo caesarean section throughout the world. These women pass through a period of post operative pain and a morbidity period. These women translate into a substantial portion of population and hence there is a load on the financial resources of healthcare system. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load but also help in early recovery of the patient.Aim:The aim of this study is to compare the effects of alternative techniques for closure of subcutaneous fat and skin on maternal health and use of healthcare resources in caesarean section.Materials and Methods:Patients undergoing Caesarean section were divided in two groups of one thousand patients each. Patients with hematological disorders or a malignancy, diabetes, septicemia or chorioamnionitis were excluded from the study. In all the patients, after stitching the uterus, the rectus sheath was stitched with thread vicryl No.1 (synthetic absorbable braided sutures with polyglycolic acid, polycaprolactone and calcium stearate coating), using a round body needle. Then the patients were divided into two groups. In group I, vicryl No.1 thread used in stitching of the rectus sheath was continued into the skin with application of subcuticular stitches, after securing the edges with a knot. In group II, after stitching the rectus sheath with vicryl No. 1, the thread was cut and interrupted sutures were applied in subcutaneous fat with thread vicryl No. 2. Skin was stitched with subcuticular stitches using proline 2, a non-absorbable propylene suture. The two groups of patients were observed for the duration of surgery, post-operative pain in stitches, patient satisfaction about removal of stitches, evidence of wound infection or seroma, and cosmetic results.Results:It was noted that the duration of surgery in group I was on average 7.5 minutes less as compared to the duration in group II. Patients in group I were more satisfied with the results of the surgery and were relieved to know that their stitches did not need to be removed.Conclusion:Although no difference was found in the rates of wound infection and formation of scar tissue between the group I and group II, the duration of surgery was less and the patients were more satisfied in group I.

Closure of Pfannenstiel skin incisions in cesarean sections: comparison of wound outcomes with interrupted mattress vs. subcuticular suture

“…The goals of wound closure include obliteration of dead space, even distribution of tension along deep suture lines, and maintenance of tensile strength across the wound. 5 Many techniques and suture materials have been tried to achieve closure and restore the structural and functional anatomy of skin. Suture materials that have been tried are natural and synthetic materials, which are absorbable and non-absorbable.…”

“…9 Best ways to close skin incisions for optimal results are still under experimentation. 5,10 There is a need to identify the right method and suture material to provide the best wound outcomes. The method should have less postoperative morbidity, help faster recovery and be cost effective at the same time.…”

A randomised controlled trial on suture materials for skin closure at caesarean section: Do wound infection rates differ?

“…6,[9][10][11][12][13] This variation probably results from several factors in the various studies. [9][10][11][12][13] Firstly, studies with broad exclusion criteria have lower wound complication rates than studies with stringent exclusion criteria. The wound complication rate in our study was 7%, with the only exclusion criterion being declining to participate.…”

“…Secondly, studies (including our study) in which the subcutaneous fat layer was sutured prior to skin closure, reported lower wound complication rates than those in which the subcutaneous fat layer had not been sutured. 4,6,11 A limitation of our study was that we did not measure BMI and therefore did not compare wound infection rates in different BMI groupings. The mean weights in all 3 groups were similar.…”

A comparative study on wound outcome after non approximation against approximation of subcutaneous layer during emergency caesarean section in patients with abdominal subcutaneous layer > 2 cm

“…These women pass through a period of postoperative pain and a morbidity period. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load but also help in early recovery of the patient 5 . The best way of closing the mother's skin layer after caesarean section has been a topic of debate.…”