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

Abstract

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.

Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

“…Women whose surgery duration was between 30 and 45 minutes had worse functional status at POD 30 compared to those whose surgery duration was equal to or less than 30 minutes. Surgery length varies by health providers and by intraoperative complications [28,29,30]. In this study, women who had intraoperative complications were four times as likely to report poor function at POD 30 than those with no intraoperative complications.…”

Comparison of the effect of skin closure materials on skin closure during cesarean delivery

“…The NMA for time to skin closure of dermal and epidermal layer (seconds) included 12 RCTs [ 13 – 24 ] (10 two-arm studies, 2 three-arm studies) covering four skin closure materials ( Fig 3A ). Eight nodes were included in the NMA.…”

“…The NMA for Skin separation included 11 RCTs [ 17 , 18 , 22 , 24 – 35 ] (11 two-arm studies) covering five skin closure materials ( Fig 4A ). Nine nodes were included in the NMA.…”

Subcuticular suture and incisional surgical-site infection in elective hepatobiliary and pancreatic surgery: an open-label, pragmatic randomized clinical trial (CLOSKIN trial)

“…The e cacy of subcuticular suture on reduction of si-SSI has been widely investigated. Subcuticular suturing is accepted as the procedure of choice for clean surgical procedures (wound class 1 according to the CDC criteria) (21). It is associated to a signi cant improve on wound aesthetics and requires no removal of surgical stiches, therefore facilitating postoperative recovery and a prompt transitioning to patient's daily routine averting need for re-consultation (21,22).…”