Skin closure options for cesarean delivery: Glue vs. subcuticular sutures
In a study to be presented Thursday, Jan. 26, in the oral concurrent session at 1:15 p.m. PST, at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting™, researchers will present their findings in a study titled, Comparison of skin closure at cesarean delivery, Glue (Dermabond) versus Intra-cuticular (Monocril) sutures: A Randomized Controlled Trial.
Cesarean delivery rates have increased during the last few decades and it has become the most common surgery during a woman's reproductive years. There is currently no definite evidence regarding the best method for skin closure after a cesarean surgery. Safety of the operation, healing and cosmetic outcomes are important and should influence the physician's choice of skin closure methodology.
In this randomized controlled trial, pregnant women undergoing a scheduled cesarean delivery were randomly assigned to skin closure with glue (Dermabond) or with a monofilament synthetic suture (Monocryl). Scars were evaluated after eight weeks. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) scores. Secondary outcome measures were surgeon satisfaction, duration of surgery, duration of hospitalization after the cesarean delivery and complications of surgical site infection or wound complications at the incision.
"Interestingly, we compared the results immediately after the cesarean delivery and within eight weeks from surgery using a validated and reliable instrument that is practical for assessing scars–POSAS," explained Yair Daykan, M.D., with the Dept. of Obstetrics and Gynecology at Meir Medical Center in Kfar Saba and the Sackler School of Medicine in Tel Aviv. Dr. Daykan is also the presenter of the research at the SMFM annual meeting.
The researchers found that when both a physician, unaware of the skin closure method, and the patients themselves assessed the scar there were no significant differences found between the two groups in blood loss, infections and length of postpartum hospitalization or wound disruption. Glue and suture skin closure scores using POSAS were similar eight weeks after surgery.
"Both methods were shown to be safe and successful for skin closure after a scheduled cesarean delivery and, therefore, can be used based on the surgeon's and patient's preferences," added Daykan.
A copy of the abstract is available at http://www.smfmnewsroom.org and below. For interviews please contact Vicki Bendure at [email protected] 202-374-9259 (cell).
About the Society for Maternal-Fetal Medicine
The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed. For more information visit http://www.smfm.org.
Abstract #36 Comparison of skin closure at cesarean delivery, glue (Dermabond) versus intra-cuticular (Monocril) sutures: A randomized controlled trial
Yair Daykan, Yael Pasternak, Maya Sharon Weiner, Keren Tzadikevitch-Geffen, Rivka Sukenik Halevy, Tal Biron-Shental Department of OBGYN, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
OBJECTIVE: The optimal choice of skin closure at cesarean delivery has not yet been determined. Our aim was to compare wound complications and scar healing between glue (Dermabond) versus mono filament (Monocril) intra-cuticular suture for skin closure after a scheduled cesarean delivery. STUDY DESIGN: We conducted a randomized controlled trial in which pregnant women undergoing a scheduled cesarean delivery were randomly assigned to skin closure with glue (Dermabond) or with a monofilament synthetic suture (Monocryl). The dermis in both groups was sutured. Outcome assessors were blinded to group allocation. Scars were evaluated after 8 weeks. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) scores. Secondary outcome measures were surgeon satisfaction, duration of surgery, duration of hospitalization after the cesarean delivery and complications of surgical site infection (SSI) or wound disruption (hematoma or seroma). Sample size calculation showed that 104 women had to be randomized in order to have 80% power to answer the primary question.
RESULTS: Demographic characteristics and indications for cesarean delivery were similar in both groups. There were no significant differences between the dermabond and the monocril intra-cuticular closure POSAS scores eight weeks after surgery (p¼0.969 patient score, p¼0.495 observer score). Subcutaneous thickness was similar in both groups (mean 1.60.49 cm; p¼0.775). There were no differences between the glue group and the suture group related to length of surgery (3711 min and 4114 min, p¼0.411). We found no difference in surgeon scores relating to time of procedure and satisfaction (p¼0.275, p¼0.259, p¼0.335). Two patients in the glue group had mild wound disruption without significance. BMI and duration of surgery were not relevant factors in these cases. No significant differences were found regarding surgical site infection or blood cell count parameters between the groups.
CONCLUSION: Skin closure using glue (Dermabond) or a mono- filament synthetic suture (Monocryl) had similar results. Both methods were shown to be safe and successful for skin closure at cesarean delivery and therefore, can be used based on surgeon and patient preferences. (Level I evidence).
TRIAL REGISTRATION: ClinicalTrials.gov NCT02831946.