BACKGROUND AND PURPOSE: 

• Data supports skin closure for cesarean sections with subcuticular suture rather than staples  
• Fox et al. (Obstet Gynecol., 2018) compared wound complications in women who received suture vs staple closure technique during tertiary or higher-order C-section

METHODS: 

• Retrospective cohort study  
• Participants: Women undergoing tertiary or higher-order C-sections  
• Cohorts not overlapping 
  • Prior to 2011 standard was staple closure, with suture closure beginning in spring of 2011  
• Patients received  
  • Appropriate prophylactic antibiotics  
  • Group practice is to close all layers (including peritoneum and rectus muscles) 
  • Closure of subcutaneous tissue if ≥2 cm  
  • Postop subcutaneous heparin if BMI >40  
• Decision of staples vs suture left to surgeon’s discretion  
• Staples: Removed postop day 4-7 
• Sutures: Running subcuticular suture of either 3-0 poliglecaprone (Monocryl) or 4-0 polyglactin (Vicryl) suture  
  • Wound closure strips removed 2 weeks later  
• Primary outcome: Wound complication, defined as  
  • Wound infection requiring antibiotics or  
  • Wound separation requiring wound packing or  
  • Reclosure any time up to 6 weeks after delivery 

RESULTS: 

• 551 patients were involved in the study 
  • 192 (34.8%) received staple closure 
  • 359(65.2%) received suture closure 
• Suture closure was associated with a lower rate of wound complication (P=0.003) 
  • Suture: 4.7% (95% CI 3.0%-7.5%) 
  • Staple: 11.5% (95% CI 7.7%-16.7%) 
• Suture closure remained independently associated with a lower risk of a wound complication even after controlling for number of prior C-sections and participation of a resident in the closure 
  • Adjusted odds ratio 0.44 (95% CI 0.23-0.86) 
• Suture closure was associated with 
  • Longer operative time of approximately 10 minutes 
  • Shorter hospital stay (3 vs 4 days)

CONCLUSION: 

• Suture closure is associated with an approximately 50% lower risk of wound complication (separation or infection) in women receiving a tertiary or higher-order C-section 
• These data are in keeping with similar results for first or second cesarean section (see ‘Related ObG Topics’ below)

Learn More – Primary Sources: 

Suture Compared With Staple Closure of Skin Incision for High-Order Cesarean Deliveries.

Related ObG Topics:

Can Evidence Based Interventions Reduce C-section Complications?

Suture or Staple for Cesarean Section Skin Closure?

Which is the Better Suture to Prevent C-Section Wound Complications? 

C-Section Skin Closure: Glue or Subcuticular Sutures?

Knotless Barbed Suture and Uterine Closure at Cesarean Section

Suture or Staples for Vertical Wound Closure in Obese Women?  

Does Changing Gloves Decrease Cesarean Wound Infection?