Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery

Basha, Suzanne; Rochon, Meredith; Quiñones, Joanne N.; Coassolo, Kara M.; Rust, Orion A.; Smulian, John C.

doi:10.1016/j.ajog.2010.07.011

Cited by 105 publications

(91 citation statements)

References 5 publications

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“…Chlorhexidine gluconate (CHG) wipes rather than povidone-iodine (PVP-I) were used to prep the incision area [3]. Intra-operatively, extra care was taken when removing drapes and the use of sutures rather than staples on fat layers > 2 cm were introduced [4]. Post-operative wound interventions were also revised: Dressings were changed on day three unless required because of saturation.…”

Section: Methodsmentioning

confidence: 99%

A Journey to Zero: Reduction of Post-Operative Cesarean Surgical Site Infections over a Five-Year Period

Hickson

Harris

Brett

2015

Surgical Infections

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Background: Surgical site infections (SSI) are a substantial concern for cesarean deliveries in which a surgical site complication is most unwelcome for a mother with a new infant. Steps taken pre-and post-operatively to reduce the number of complications may be of substantial benefit clinically, economically, and psychologically. Methods: A risk-based approach to incision management was developed and implemented for all cesarean deliveries at our institution. A number of incremental interventions for low-risk and high-risk patients including pre-operative skin preparations, standardized pre-and post-operative protocols, post-operative nanocrystalline silver antimicrobial barrier dressings, and incisional negative pressure wound therapy (NPWT) were implemented sequentially over a 5-y period. A systematic clinical chart review of 4,942 patients spanning all cesarean deliveries between 2007-2012 was performed to determine what effects the interventions had on the rate of SSI for cesarean deliveries. Results: The percentage of SSI was reduced from 2.13% (2007) to 0.10% (2012) (p < 0.0001). There were no substantial changes in the patient population risk factors over this time. As a result of the changes in incision management practice, a total of 92 cesarean post-operative SSIs were avoided: A total cost saving of nearly $5,000,000. Conclusion: Applying a clinical algorithm for assessing the risk of surgical site complication and making recommendations on pre-operative and post-operative incision management can result in a substantial and sustainable reduction in cesarean SSI.

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Section: Methodsmentioning

confidence: 99%

A Journey to Zero: Reduction of Post-Operative Cesarean Surgical Site Infections over a Five-Year Period

Hickson

Harris

Brett

2015

Surgical Infections

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…2 However, they are more expensive than suture materials and it is reported that SS are more painful and result in a poorer cosmetic appearance. 3 Most studies on suture materials and SS for skin closure following CS are limited to cosmetic aspects, patient satisfaction and postoperative pain relief, [4][5][6] with conflicting outcomes. Furthermore, these studies were done in high-income countries.…”

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confidence: 99%

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

et al. 2012

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“…Wound complications led to a decrease in patient satisfaction, however it was not statistically significant to associate staples with decreased satisfaction. 15 Cromi et al, found there were equivalent cosmetic outcome amongst closure methods.…”

Section: Type Of Closure Technique: Mean Time For Closure and Cosmetimentioning

confidence: 98%

Skin stapler versus sutures in abdominal wound closure

Varghese¹,

Gamalial

Kurien

2017

Int Surg J

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INTRODUCTIONThe suturing of any incision or wound needs to take into consideration the site and tissues involved and the technique for closure should be chosen accordingly. Therefore, the correct choice of suture technique and suture material is vital, but will never compensate for inadequate operative technique, and for any wound to heal well, there must be a good blood supply and no tension on the closure. 1 The selection of the proper incision, suture material, and closure technique is very important to assist the patient's own repair mechanism and restore normal anatomic relationships after surgery. Attention to these details also prevents such complications as dehiscence and infection, assuring a good cosmetic result. Surgical site infections (SSIs) are infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure. SSIs are classified into incisional and organ/space infections, and the former are further sub-classified into superficial (limited to skin and subcutaneous tissue) and deep incisional ABSTRACT Background: Wound closure is as important as any other action performed by the surgeon. Apart from the need for producing a healthy and strong scar, it is the surgeon's responsibility to ensure its aesthetically pleasing physical appearance. Skin staples are an alternative to regular sutures in offering this advantage. The present study has helped to highlight the benefits of skin stapler. Methods: Out of the 120 participants, 60 underwent skin closure with Stainless steel skin staples and the remaining 60 with non-absorbable Polyamide mattress sutures randomly. They all received one mandatory dose of pre-operative parenteral antibiotic 1 hour prior to the incision. On the 3 rd postoperative day, the wound was evaluated for inflammation, infection and wound gape. Participants were re-evaluated for infection/gape/inflammation during follow-up on 7 th day. The wounds were evaluated at 1 months follow up which were rated for cosmesis by Visual Analogue Score. The data was coded and entered in Microsoft excel and then analysed using statistical software SSPS. Results: Study population consisted of 79 males (65.8%) and 41 females (34.2%). Mean age of the study population was 49.35 with an SD 16.739. Wound infection was found to be higher in stapler group (30%) when compared to conventional suture group (11.7%)which was found to be statistically significant with chi-square value 6.114 and p value 0.013. Mean time for closure was significantly shorter in stapler group 4.55 minutes, when compared to suture group (11.22 minutes). Better cosmetic outcome was observed in conventional suture group. Conclusions: Preventing wound infection, especially in abdominal wounds, is of importance as it may lead to wound gaping. Incidence of post-operative wound infection was more with skin staples. Cosmesis is essential and important aspect in this day and age. A cosmetic scar not only gives satisfaction to the patient but also mental ease to the surgeon. Conventional sutures provi...

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Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery

Cited by 105 publications

References 5 publications

A Journey to Zero: Reduction of Post-Operative Cesarean Surgical Site Infections over a Five-Year Period

A Journey to Zero: Reduction of Post-Operative Cesarean Surgical Site Infections over a Five-Year Period

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

Skin stapler versus sutures in abdominal wound closure

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