Techniques for wound closure at caesarean section: a randomized clinical trial

Graaf, Irene M. de; Rengerink, Katrien Oude; Wiersma, I. C.; Donker, Marielle Eveline; Mol, Ben Willem; Pajkrt, Eva

doi:10.1016/j.ejogrb.2012.07.019

Cited by 26 publications

(24 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Novetsky¹,

Zighelboim²,

Guntupalli³

et al. 2014

Gynecologic Oncology

View full text Add to dashboard Cite

Objectives Obese women have a high incidence of wound separation after gynecologic surgery. We explored the effect of a prospective care pathway on the incidence of wound complications. Methods Women with a body mass index (BMI)≥30kg/m2 undergoing a gynecologic procedure by a gynecologic oncologist via a vertical abdominal incision were eligible. The surgical protocol required: skin and subcutaneous tissues to be incised using a scalpel or cutting electrocautery, fascial closure using #1 polydioxanone suture, placement of a 7mm Jackson-Pratt drain below Camper’s fascia, closure of Camper’s fascia with 3-0 plain catgut suture and skin closure with staples. Wound complication was defined as the presence of either a wound infection or any separation. Demographic and perioperative data were analyzed using contingency tables. Univariable and multivariable regression models were used to identify predictors of wound complications. Patients were compared using a multivariable model to a historical group of obese patients to assess the efficacy of the care pathway. Results 105 women were enrolled with a median BMI of 38.1. Overall, 39 (37%) had a wound complication. Women with a BMI of 30–39.9 kg/m2 had a significantly lower risk of wound complication as compared to those with a BMI >40 kg/m2 (23% vs 59%, p<0.001). After controlling for factors associated with wound complications the prospective care pathway was associated with a significantly decreased wound complication rate in women with BMI<40kg/m2 (OR 0.40, 95% C.I.: 0.18–0.89). Conclusion This surgical protocol lead to a decreased rate of wound complications among women with BMI 30–39.9 kg/m2.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Novetsky¹,

Zighelboim²,

Guntupalli³

et al. 2014

Gynecologic Oncology

View full text Add to dashboard Cite

show abstract

“…Our sample size almost doubles the data from all six prior randomized studies published on pain perception between sutures and staples for cesarean delivery skin closure. [6][7][8][9][10][11] This study was limited by our ability to contact all patients for the postdischarge follow-up pain assessments: these data were available for 291 women (79%) who received suture closure and 298 women (79%) who received staple closure.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 In fact, pain perception at discharge has been assessed in only six randomized controlled trials comparing suture with staples for cesarean skin closure, five of which had fewer than 150 total patients enrolled. [6][7][8][9][10][11] The objective of this secondary analysis of our randomized trial was to compare patient-reported pain Unauthorized reproduction of this article is prohibited. and pain medication use associated with suture and staple skin closure after cesarean delivery performed through low transverse skin incisions.…”

Section: Methodsmentioning

confidence: 99%

Pain Associated With Cesarean Delivery Skin Closure

Mackeen

Khalifeh

Fleisher

et al. 2015

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…The only two studies available at the time of conception of our study had several methodological limitations including the use of a non-validated or undetermined scar evaluation tool, absent or undetermined observer blinding and scar assessment only six weeks or four months postoperatively [10] , [12] . Two other studies were published after our study was initiated [9] , [11] . Huppelschoten et al [9] detected no difference, whereas de Graaf et al [11] found that suture closure of the subcutaneous fat compared to non-closure was associated with worse cosmetic outcome.…”

Section: Discussionmentioning

confidence: 99%

Suture Closure versus Non-Closure of Subcutaneous Fat and Cosmetic Outcome after Cesarean Section: A Randomized Controlled Trial

et al. 2014

View full text Add to dashboard Cite

IntroductionTo investigate the effect of subcutaneous fat suture closure versus non-closure at cesarean section (CS) on long-term cosmetic outcome.Material and MethodsWomen undergoing planned or unplanned CS were randomized to either subcutaneous fat suture closure or non-closure using a 1∶1 allocation algorithm. Participants and outcome assessors were blinded to group allocation. Scar evaluation was performed after two and six months. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) summary scores six months after surgery. Secondary outcome measures were Vancouver Scar Scale (VSS) summary scores, retraction of the scar below the level of the surrounding skin, duration of surgery, and development of hematoma, seroma, surgical site infection (SSI) or wound disruption. Data were analyzed according to the intention to treat principle.ResultsA total of 116 women were randomized and 91 participants, 47 in the closure and 44 in the non-closure group, completed the trial and were analyzed. There were no differences in patient morphometrics or surgery indications between groups. At two and six months no significant differences were found with respect to POSAS or VSS scores between groups. After two months significantly more women in the non-closure group described their scar as being retracted below the level of the skin (36% vs. 15%, p = 0.02) whereas no difference was observed at six months. There were significantly more hematomas in the non-closure (25%) compared to the closure group (4%) (p = 0.005). There was no difference in duration of surgery, SSI, seroma formation or wound disruption between groups.ConclusionsSuture closure of the subcutaneous fat at CS does not affect long-term cosmetic outcome. (Level I evidence).Trial RegistrationClinicalTrials.gov NCT01542346.

show abstract

Techniques for wound closure at caesarean section: a randomized clinical trial

Cited by 26 publications

References 13 publications

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

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

Pain Associated With Cesarean Delivery Skin Closure

Suture Closure versus Non-Closure of Subcutaneous Fat and Cosmetic Outcome after Cesarean Section: A Randomized Controlled Trial

Contact Info

Product

Resources

About