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Comparison of Subcuticular Suture Type for Skin Closure After Cesarean Delivery: A Randomized Controlled Trial

Buresch, Arin M. MD; Van Arsdale, Anne MD, MSc; Ferzli, Myriam MD; Sahasrabudhe, Nicole MD; Sun, Mengyang MD; Bernstein, Jeffrey MD; Bernstein, Peter S. MD, MPH; Ngai, Ivan M. MD; Garry, David J. DO

doi: 10.1097/AOG.0000000000002200
Contents: Original Research

OBJECTIVE: To compare the rate of wound complications among women who underwent cesarean delivery through a Pfannenstiel skin incision followed by subcuticular closure with either poliglecaprone 25 suture or polyglactin 910 suture.

METHODS: Patients undergoing nonemergent cesarean delivery at or beyond 37 weeks of gestation were randomized to undergo subcuticular skin closure with either poliglecaprone 25 or polyglactin 910. The primary outcome was a wound composite outcome of one or more of the following: surgical site infection, wound separation, hematoma, or seroma within the first 30 days postpartum. To detect a reduction in the primary outcome rate from 12% to 4%, with a power of 0.90 and a two-tailed α of 0.05, 237 women per study group were required. Analysis was performed according to the intent-to-treat principle.

RESULTS: From May 28, 2015, to August 5, 2016, 275 women were randomized to poliglecaprone 25 and 275 to polyglactin 910, of whom 520 (95%) were included in the final analysis: 263 in the poliglecaprone 25 group [of whom 231 (88%) actually underwent poliglecaprone 25 closure) and 257 in the polyglactin 910 group [of whom 209 (81%) actually underwent polyglactin 910 closure]. The groups were similar in demographic characteristics, medical comorbidities, and perioperative characteristics. Poliglecaprone 25 was associated with a significantly decreased rate of overall wound complications when compared with polyglactin 910, 8.8% compared with 14.4% (relative risk 0.61, 95% CI 0.37–0.99; P=.04).

CONCLUSION: Closure of the skin after cesarean delivery with poliglecaprone 25 suture decreases the rate of wound complications compared with polyglactin 910 suture.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02459093.

Closure of the skin after cesarean delivery with poliglecaprone 25 suture decreases the rate of cesarean wound complications compared with polyglactin 910 suture.

Department of Obstetrics & Gynecology and Women's Health and the Department of Anesthesiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.

Corresponding author: Arin M. Buresch, MD, Kaiser Permanente, Viewridge Medical Offices, 5251 Viewridge Court, San Diego, CA 92123; email: arin.m.buresch@kp.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the Society of Maternal-Fetal Medicine's 37th Annual Pregnancy Meeting, January 23–28, 2017, Las Vegas, NV.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.