DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20203844

Which is better for pfannensteil skin incision closure in caesarean section? Interrupted mattress suture or continuous subcuticular suture

Shridevi A S., Madhusoodana R. Bhovi, Prema Prabhudeva, Renuka ., Camelia Maitra

Abstract


Background: Caesarean delivery is one of the most commonly performed operations in obstetrics. Postoperative comfort of the woman largely depends on the method of skin closure. Wound complications from caesarean delivery such as dehiscence or infection cause a significant emotional and economic burden in obstetric care. There are many methods and techniques for skin wound closure in caesarean section. Each technique has its own advantages and disadvantages. The aim and objective of this study was to compare the wound outcomes in Pfannensteil incisions closed with mattress sutures using nonabsorbable suture and subcuticular sutures using absorbable sutures in caesarean deliveries.

Methods: It is a prospective observational study done on 216 consecutive pregnant women who were admitted to labor room for elective or emergency caesarean section. Patients undergoing caesarean section with Pfannensteil incision between February 2019 to October 2019 were included in this study. Among 216 women, 108 women had mattress sutures and 108 women had subcuticular sutures for skin wound closure. The primary outcome studied was wound complications including erythema, wound dehiscence, burst abdomen, infection and pain which was studied on postoperative day 3-7. The secondary outcome was assessed at 6 weeks follow-up in terms of pain, cosmetic appearance of scar and patient satisfaction about scar.

Results: A total of 216 pregnant women undergoing caesarean section were studied who had similar baseline characteristics and risk factors. However, women with previous caesarean section were more in mattress group. The overall incidence of erythema, surgical site infection, wound dehiscence, resuturing and pain was more in mattress group and was statistically significant. During follow-up at 6 weeks, women with subcuticular sutures had cosmetically better scar and more satisfied with their scars than women with mattress sutures but the pain level was same in both groups.

Conclusions: Authors conclude that compared to mattress sutures, subcuticular sutures cause significantly fewer wound complications and pain in postoperative period. Also, subcuticular sutures are associated with cosmetically appealing scars and higher patient satisfaction. But there was no difference in pain level at 6 weeks in both methods of skin closure.


Keywords


Caesarean section, Mattress sutures, Subcuticular sutures, Suture materials, Wound healing

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References


Akolekar R. Surgical techniques for caesarean delivery. The caesarean birth. 1st edition. Chapter 6: 1991.

Hema KR, Johanson R. Techniques for performing caesarean section. Best Pract Res Clin Obstet Gynaecol. 2001;15(1):17-47.

Wylie BJ, Gilbert S, Landon MB, Spong CY, Rouse DJ, Leveno KJ, et al. Comparison of transverse and vertical skin incision for emergency cesarean delivery. Obstet Gynecol. 2010;115(6):1134-40.

Altman AD, Allen VM, McNeil SA, Dempster J. Pfannenstiel incision closure: a review of current skin closure techniques. J Obstet Gynecol Canada. 2009;31(6):514-20.

Ramsey PS, White AM, Guinn DA, Lu GC, Ramin SM, Davies JK, et al. Subcutaneous tissue re-approximation, alone or in combination with drain, in obese women undergoing cesarean delivery. Obstet Gynecol. 2005;105:967-73.

Tuuli MG Rampersad RM, Carbone JF, Stamilio D, Macones GA, Odibo AO. Staples compared with subcuticular suture for skin closure after cesarean delivery: a systemic review and meta analysis. Obstet Gynecol. 2011;117(3):682-90.

Walter JB, Israel MS. Wound healing, Textbook of general pathlogy, 6th ed. Ch.9:124-5.

Choudhary A, Bansal N, Chaudhari P. Closure of pfannenstiel skin incisions in cesarean sections: comparison of wound outcomes with interrupted mattress vs. subcuticular suture. Int J Reprod Contracept Obstet Gynecol. 2017;6:2964-8.

Mackeen AD, Berghella V, Larsen ML, Techniques and materials for skin closure in caesarean section. Cochrane Database Syst Rev. 2012;11:CD003577.

Clay FS, Walsh CA, Walsh SR. Staples vs. subcuticular sutures for skin closure at cesarean delivery: a metaanalysis of randomized controlled trials. Am J Obstetric Gynecol. 2011;204(5):378-83.

Guruswamy KS, Toon CD, Allen VB, Davidson BR. Continous versus intrupted sutures for non-obstetric surgery. Cochrane Database Syst Rev. 2014;14-2:CD010365.

Alderdice F, McKenna D, Dornan J. Techniques and materials for skin closure in caesarean section. Cochrane Data Syst Rev. 2003;2:CD003577.

Kudur MH, Pai SB, Sripathi H, Prabhu S. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009;75:425-34.

Akhila V, Vidhyashree GP, Shantala R, Jyothi S, Pratap K. Subcuticular versus mattress skin closure techniques following OBGYN laparotomies by low transverse incision. IOSR J Pharma. 2016;6(11):42-6.

Nguyen DT, Orgill DP, Murphy GF. Chapter 4: pathophysiologic basis for wound healing and cutaneous regeneration. biomaterials for treating skin loss. Woodhead Publishing (UK/Europe) and CRC Press (US), Cambridge/Boca Raton; 2009:25-57.

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP) arthritis care and research. 2011;63(11):S240-S252.

Tanaka A, Sadahiro S, Suzuki T, Okada K, Saito G. Randomized controlled trial comparing subcuticular absorbable suture with conventional interrupted suture for wound closure at elective operation of colon cancer. Surg. 2014;155(3):486-92.