Comparison of Three Techniques for Skin Closure in Caesarean Delivery (Absorbable Subcuticular Sutures,...

Caesarean section is associated with post-operative surgical complications such as wound disruption, induration and hematoma. It is essential to optimize surgical techniques to ensure the best possible outcomes for women undergoing caesarean section.

This was a randomized controlled trial done at a tertiary care centre. A total of 300 women undergoing first caesarean section were randomly allocated to absorbable subcuticular sutures (n = 100), non-absorbable nylon sutures (n = 100) and surgical staplers (n = 100) for skin closure. Post-operative wound complications, pain, cosmetic appearance, closure time, and surgeon's and patient's satisfaction were recorded post-operatively on day 3, days 7-10 and at weeks 4-6. The primary outcome was rate of wound disruption among the women in three groups at three occasions. The secondary outcomes were wound infection rate, induration, swelling, cosmetic appearance, pain, surgeon's satisfaction, patient's satisfaction and closure time.

Significantly more women developed wound dehiscence in the stapler group (p = 0.039) at post-operative days 7-10 while in sub-group analysis, a similar outcome was seen between the other two groups (p = 0.999). The patient's and surgeon's satisfaction and cosmesis were maximum with absorbable subcutaneous monocryl sutures and minimum with stapler skin closure. Pain was maximum after non-absorbable nylon sutures, while application time was minimum in staplers application.

Present study suggests a benefit with sutures compared to surgical staplers in terms of wound dehiscence, infection, cosmesis and patient's satisfaction. Among the methods of skin closure, absorbable subcuticular monocryl and non-absorbable nylon sutures have similar outcomes with marginal benefit in absorbable subcuticular monocryl sutures.