#Grand Rounds

Suture or Staple for Cesarean Section Skin Closure?

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BACKGROUND AND PURPOSE:  

  • Mackeen et al. (AJOG, 2017) sought to determine whether absorbable sutures or metal staples are superior for transverse cesarean section incision closure 

METHODS: 

  • Systematic review and meta-analysis comparing sutures to metal staples
  • Compared wound complications, patient pain perception, patient satisfaction, cosmesis as assessed by the physician and patient, and operating time 

RESULTS: 

  • 3112 patients were included  
  • Patients with sutures were 71% significantly less likely to suffer wound complications 
    • 2.52% vs 9.40%; relative risk (RR) 0.29; 95% CI 0.20–0.43; P < .01 
  • The lower number of wound complications was due to fewer wound separations 
  • Operating time was 7.20 minutes longer using sutures (95% CI, 3.10–11.31; P < .01) 
  • Other outcomes were not significantly different between the two groups, including hematoma, seroma and readmission  
  • Obese patients  
    • 49% less likely to have wound complications with sutures (6.69% vs 12.84%; RR 0.51; 95% CI 0.34–0.75) 
  • Nonobese patients  
    • 62% less likely to have wound complications with sutures (4.27% vs 11.24%; RR, 0.38; 95% CI 0.23–0.64) 

CONCLUSION: 

  • Cesarean section closure using suture leads to slightly longer OR time but fewer wound complications due to wound separation in both obese and nonobese patients 

Learn More – Primary Sources:  

Suture versus staples for skin closure after cesarean: a meta-analysis

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Related ObG Topics:

Suture or Staples for Vertical Wound Closure in Obese Women?  
Which is the Better Suture to Prevent C-Section Wound Complications? 
C-Section Skin Closure: Glue or Subcuticular Sutures?

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