Value of Subcutaneous Drainage System in Obese Females Undergoing Cesarean Section Using Pfannenstiel Incision

Abstract

Objective: To determine whether closed subcutaneous drainage systems were efficacious in reducing the rate of wound breakdown of Pfannenstiel incision after cesarean section (CS) in obese females. Design: Prospective controlled clinical trial. Participants: 118 obese pregnant females with a body mass index >32 undergoing CS were divided into two groups: group I (n = 78) with closed subcutaneous drainage system and group II (n = 40) without drainage system. Incision closure technique was standardized. Prophylactic antibiotics were given routinely to both groups. Outcome Measures: Primary outcomes were the incidence of wound breakdown in both groups together with rate of hematoma formation and occurrence of fever. Secondary outcomes were amount of fluid drained, need for redressing. Results: Wound breakdown occurred in 9 cases in group I (11.5%), while it happened in 5 cases in group II (12.5%) (p > 0.05). Relative risk was 0.92 (95% CI 0.26–3.75). Hematoma formation was observed in only 1 case in the nondrainage group (group II). Fever was observed in 18 cases in group I (23.1%) in the first 24 h postoperative while in group II, 13 cases developed fever (32.5%) (p > 0.05). The need for redressing within the first 24 h was only in 2.5% of cases in group I while it was 17.9% in group II (p < 0.05). Conclusion: We found no significant benefit in using a subcutaneous drain as a prophylactic measure against wound breakdown in obese pregnant females undergoing CS as long as they received a prophylactic antibiotic.

Subcutaneous Tissue Reapproximation, Alone or in Combination With Drain, in Obese Women Undergoing Cesarean Delivery

“…15,16,18,21,23,24,26 -28 To date, 5 previous studies have evaluated the independent use of subcutaneous drainage to prevent wound complications in women undergoing cesarean delivery. 15,16,18,21,23 Allaire et al 15 compared the use of subcutaneous suture closure with subcutaneous drain in women undergoing cesarean delivery. These investigators demonstrated a reduction in the wound complication rate in women who received subcutaneous drain when compared with women treated with suture closure or those receiving neither drain or suture subcutaneous closure.…”

Obesity and the challenges of caesarean delivery: Prevention and management of wound complications

“…In a prospective caseecontrol study conducted in Egypt evaluating 118 women with a BMI >32 kg/ m 2 undergoing CS with a Pfannenstiel incision, no difference in wound dehiscence or haematoma formation was found between those who had subcutaneous drains and those who did not [38]. In a retrospective US cohort of 194 patients with a BMI >50 kg/m 2 undergoing CS, the use of subcutaneous drains was associated with an increased risk of wound complications (OR 2.3 95% CI 1.23e4.38) [13].…”

Role of subcutaneous closed vacuum drain in preventing surgical site infection in emergency surgery for perforative peritonitis: A randomized control study

“…There are no studies on usage of subcutaneous closed suction drain in emergency laparotomies for perforative peritonitis in the literature. However, similar studies using subcutaneous closed suction drain have been done for colorectal surgeries, caesarean delivery and other elective abdominal surgeries 13,[15][16][17][18][19][20][21] . In a study conducted by Ahmet et.…”

“…A randomized controlled trial by Baier at al 20 on 200 patients showed that subcutaneous Redon drains do not reduce the incidence of surgical site infections after laparotomy. Al-Inany et al 21 carried out a prospective controlled clinical trial on 118 obese pregnant females with a body mass index >32 undergoing cesarean section which showed no significant benefit in using a subcutaneous drain as a prophylactic measure against wound breakdown. In our study, it was found that the incidence of SSI in control group without a subcutaneous suction drain was 58% where as it was 16% in the group with such drain.…”