Suture production

All Sewn Up: Postcesarean Skin Staples vs. Subcuticular Sutures Subcuticular closure was associated with lower risk for wound complications.

As the cesarean delivery rate climbs, we are increasingly obliged to determine best practices for the procedure. In particular, averting wound-related complications would lower postcesarean morbidity considerably. Whether skin staples are better than subcuticular suture closure is not known; thus, investigators in Alabama conducted a randomized, controlled trial of the two methods in 393 women undergoing scheduled or unscheduled cesarean deliveries.

Regardless of maternal body-mass index (BMI; mean, 36 kg/m 2 ), women in the staple group were more likely than those in the suture group to suffer wound disruption or infection by 4 to 6 weeks postpartum (14.5% vs. 5.9%; relative risk, 2.5). Most complications consisted of wound disruption (RR, 3.8), and much of the difference in outcomes occurred before hospital discharge. Use of subcuticular closure added 10 minutes to median operating time (from 48 to 58 minutes; P <0.001). Patient-centered measures such as pain, cosmesis, and satisfaction did not differ between groups.

Comment: As we scrutinize the quality of care that we provide for its impact on patient safety and satisfaction, trials such as this are especially valuable. Although the study population was enriched for factors associated with wound complications (e.g., high body-mass index), the benefits of subcuticular closure persisted even in low-risk women (BMI <30, primary cesarean, no preceding chorioamnionitis). As the authors note, the costs associated with longer operative times are probably rivaled by costs associated with wound morbidity, the surgical stapler itself, and the time required to remove staples. This trial adds to the mounting evidence that subcuticular suturing is the best method for postcesarean skin closure.