Subcutaneous Tissue: To Suture or Not to Suture at Cesarean Section

Abstract

Objective: The null hypothesis for this investigation was that there was no difference in the frequency of wound disruption between women who had their subcutaneous tissues approximated with suture and those who did not during cesarean section. Methods: During alternating months, consecutive women delivered by cesarean section either did (N = 716) or did not (N = 693) have their subcutaneous tissues closed with suture. All data were analyzed using chi square, Student's t-test, Fisher's exact probability test, analysis of variance, or logistic regression. Results: A 32% decrease in the frequency of wound disruption was observed when subcutaneous tissues were brought into apposition with suture at cesarean section (P = 0.03). Conclusions: Closure of Scarpa's and Camper's fascia with suture during cesarean section significantly decreased the frequency of wound disruption in this population.

A phase II trial of a surgical protocol to decrease the incidence of wound complications in obese gynecologic oncology patients

“…Several interventions to reduce wound complications have been assessed, including pre-surgical antibiotic treatment and surgical site preparation,[2, 12] maintenance of normothemia, [13, 14] subcutaneous drain placement or suture closure, [15–20] subcuticular skin closure,[21–24] retention sutures,[25] wound protection devices,[26] negative pressure dressings[27] and skin sealants. [28] The results of these studies have been conflicting; many limited to obstetrical patients or have used varying definitions of obesity.…”

Role of subcutaneous closure in preventing wound complications after cesarean delivery with Pfannenstiel incision: A randomized clinical trial

“…Furthermore, Bohman et al . reported that wound disruption was found in 7.7% of 1184 women with vertical incision as opposed to 2.2% of 225 women with a Pfannenstiel incision ( P = 0.004) . As with the present investigation, Cetin and Cetin included only the transverse skin incision in their study and analyzed their cohort in two subgroups as women with a subcutaneous fat thickness less than 2 cm and more than 2 cm .…”

“…reported that a high preoperative hematocrit level was protective and the factors associated with wound complications included vertical skin incisions and endometritis . Furthermore, obesity, non‐sutured closure, four or more vaginal examinations and high body mass index were recorded as significant factors for wound disruption …”

A Simple Checklist for Preventing Major Complications Associated With Cesarean Delivery

“…19 In a subsequent investigation, Bohman and coworkers conducted a prospective controlled trial (level 1 evidence) comparing outcomes in 716 women who had a deep subcutaneous closure with outcomes in 963 women who had no closure. 20 In women who had closure of the subcutaneous layer, the rate of wound disruption was reduced by 32%. Finally, in an excellent meta-analysis, Chelmow et al reviewed three studies that included 875 patients.…”