Patient satisfaction and cosmetic outcome in a randomized study of cesarean skin closure

Fleisher, Jonah; Khalifeh, Adeeb; Pettker, Christian M.; Berghella, Vincenzo; Dabbish, Nooreen; Mackeen, A. Dhanya

doi:10.1080/14767058.2018.1474870

Cited by 17 publications

(13 citation statements)

References 17 publications

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“…71 Additionally, women also have improved preference and experience scores with suture closure. 72 One caveat is that the only difference is in wound separation; in many trials, staples were removed <4 days after surgery. Similarly, in a recent trial of obese women only, although there were no clinical differences, more women would choose suture for a future surgery.…”

Section: Repair Of Incisionmentioning

confidence: 99%

Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2)

Caughey

Wood

Macones

et al. 2018

American Journal of Obstetrics and Gynecology

203

175

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The Enhanced Recovery After Surgery Society guideline for intraoperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for intraoperative care, with primarily a maternal focus. The "focused" pathway process for scheduled and unscheduled cesarean delivery for this Enhanced Recovery After Surgery cesarean delivery guideline will consider procedure from the decision to operate (starting with the 30-60 minutes before skin incision) through the surgery. The literature search (1966-2017) used Embase and PubMed to search medical subject headings including "cesarean section," "cesarean section," "cesarean section delivery," and all pre- and intraoperative Enhanced Recovery After Surgery items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system as used and described in previous Enhanced Recovery After Surgery Society guidelines. The Enhanced Recovery After Surgery cesarean delivery guideline/pathway has created a maternal focused pathway (for scheduled and unscheduled surgery starting from 30-60 minutes before skin incision to maternal discharge) with Enhanced Recovery After Surgery-directed preoperative elements, intraoperative elements, and postoperative elements. Specifics of the intraoperative care included the use of prophylactic antibiotics before the cesarean delivery, appropriate patient warming intraoperatively, blunt expansion of the transverse uterine hysterotomy, skin closure with subcuticular sutures, and delayed cord clamping. A number of specific elements of intraoperative care of women who undergo cesarean delivery are recommended based on the evidence. The Enhanced Recovery After Surgery Society guideline for intraoperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for intraoperative care with primarily a maternal focus. When the cesarean delivery pathway (elements/processes) is studied, implemented, audited, evaluated, and optimized by maternity care teams, this will create an opportunity for the focused and optimized areas of care and recommendations to be further enhanced.

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Section: Repair Of Incisionmentioning

confidence: 99%

Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2)

Caughey

Wood

Macones

et al. 2018

American Journal of Obstetrics and Gynecology

203

175

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“…In 2018, Fleisher et al [26] evaluated patient satisfaction and patient and physician assessment of scar appearance after Cesarean skin closure with suture versus staples. The scores were assessed at a median of 46 days postoperatively.…”

Section: All Participants Enrolled In This Clinical Investigationmentioning

confidence: 99%

Photobiomodulation Improved the First Stages of Wound Healing Process After Abdominoplasty: An Experimental, Double-Blinded, Non-randomized Clinical Trial

et al. 2018

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Background Photobiomodulation is widely studied for its potential benefits in the wound healing process. Numerous scientific studies have highlighted its effect on various phases of wound repair, but clinical validations are few. This comparative trial aims to evaluate the influence of photobiomodulation on the post-abdominoplasty healing process. Methods Seventeen Caucasian women (aged 18-55) who underwent an abdominoplasty were enrolled in this doubleblinded, controlled clinical trial. The postoperative scars were divided into two areas; the right side of the scars was treated with ten sessions of photobiomodulation (consisting in three types of wavelengths). The other part of the scars was used as control and did not receive any additional treatment. Clinical assessments of both parts of the scars were scheduled at 1, 6 and 12 months postoperative. Results Within six months following surgery, significantly improved quality of the scars on the treated side compared with the untreated side was reported by patients and experienced professionals according to Vancouver Scar Scale, Patient and Observer Scar Assessment Scale (p \ 0.05) and standardized photographs (p \ 0.05). At 1 year of follow-up, patients observed no differences between the treated and untreated sides of the scars. This suggests that photobiomodulation appears to play an early role in the wound healing process, accelerating the first stages of cicatrization. Conclusion This study statistically validates the positive impact of photobiomodulation treatment on the first stages of the postoperative healing process. Carried out on Caucasians participants only, this study should, however, be performed on a more heterogeneous population to definitively confirm these effects on an international population. Clinical trial registry Registro Brasileiro de ensaios clı ´nicos: http://www.ensaiosclinicos.gov.br,Trial RBR-49PK78.

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“…Yang et al [24] concluded that intradermal vertical mattress sutures are superior cosmetically to subcuticular sutures. Greater patient and physician satisfaction and better cosmetic outcomes were observed with the suture closure method than with the staple closure method [25].…”

Section: Discussionmentioning

confidence: 98%

Wound complication among different skin closure techniques in the emergency cesarean section: a randomized control trial

Saha

Bagga

et al. 2020

Obstet Gynecol Sci

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Objective Cesarean section is the most commonly performed obstetrical surgical procedure; however, there are no standard guidelines on appropriate skin closure techniques and materials. Only few comparative studies have been conducted on different skin closure techniques, and they have shown conflicting results. Therefore, we compared different skin closure techniques during emergency cesarean section to identify the best technique with minimal wound complication rates. Methods Patients were randomized into 3 groups (group A, n=100; group B, n=102; and group C, n=98). In group A, the skin was closed using staples; in group B, via the subcuticular technique using monocryl 3-0; and in group C, using mattress suture nylon (2-0). The primary outcome was a composite of wound complications, including infection, seroma, gaping, and need for resuturing and antibiotic administration. The secondary outcome included closure time, pain perception, patient satisfaction, and cost. Analyses were performed in accordance with the intention-to-treat principle. Results The composite wound complication rate in the entire cohort was 16.6% (n=50); the complication rate was significantly higher in group A than in the other groups. Infection was the most common wound complication observed in the entire study group (86%) and was significantly higher in group A than in groups B and C (P≤0.001). Conclusion The use of staples for cesarean section skin closure is associated with an increased risk of wound complications and prolonged hospital stay postoperative visits.

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Patient satisfaction and cosmetic outcome in a randomized study of cesarean skin closure

Abstract: Satisfaction with the closure method, satisfaction with the scar's appearance, and patient and physician assessments of scar cosmesis were all superior in those closed with suture. These results further support the use of sutures for cesarean skin closure.

Cited by 17 publications

References 17 publications

Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2)

Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2)

Photobiomodulation Improved the First Stages of Wound Healing Process After Abdominoplasty: An Experimental, Double-Blinded, Non-randomized Clinical Trial

Wound complication among different skin closure techniques in the emergency cesarean section: a randomized control trial

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