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Subcuticular Suture Compared With Staples for Skin Closure After Cesarean Delivery: A Randomized Controlled Trial

Aabakke, Anna J. M. MD; Krebs, Lone MD, DMSc; Pipper, Christian B. MSc, PhD; Secher, Niels J. MD

doi: 10.1097/AOG.0b013e3182a5f0c3
Original Research

OBJECTIVE: To compare subcuticular sutures with staples for skin closure after cesarean delivery in a randomized trial in which each woman was her own control.

METHODS: Women undergoing cesarean delivery (primary, n=32; repeat, n=31) were randomized to side distribution of skin closure methods with one side of the skin incision closed with staples and the other side closed with subcuticular suture. The primary outcome was the overall preferred side of the scar 6 months postoperatively. Additional outcomes were women's preferred method of closure and cosmetically preferred side of the scar, difference in objective cosmetic scores (assessed by two plastic surgeons), and pain between the two sides of the scar and infection rate.

RESULTS: Significantly more women preferred the stapled side, both overall (odds ratio [OR] 2.55; 95% confidence interval [CI] 1.18–5.52) and cosmetically (OR 2.67; 95% CI 1.24–5.74), and reported staples as their preferred technique (OR 2.00; 95% CI 1.10–3.64). There were no significant differences in pain scores at any time. One plastic surgeon preferred the stapled side (OR 2.8; 95% CI 1.01–7.78) and scored it significantly higher on a cosmetic visual analog scale (P=.031); the other found no significant difference. There were four (6.8%) cases of infection—three on the sutured side and one bilateral.

CONCLUSION: Staples were preferred to subcuticular suture for skin closure by women after cesarean delivery.



Women preferred staples to subcuticular suture for skin closure after cesarean delivery.

Department of Obstetrics and Gynecology, University of Copenhagen, Holbæk Hospital, Holbæk, Demark; the Department of Biostatistics, University of Copenhagen, and the Research Unit, Women's and Children's Health, the Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark;and the Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.

Corresponding author: Anna Aabakke, MD, Department Obstetrics and Gynecology, University of Copenhagen, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark; e-mail:

Supported by grants from the Faculty of Health, University of Copenhagen, and The Region Zealand Health Sciences Research Foundation.

The authors thank Christen Krag, MD, DMSc, and Camilla Asklund, MD, PhD, Department of Plastic Surgery, University of Copenhagen, Herlev Hospital, for their thorough and excellent evaluation of the scars, and the midwives at the Department of Obstetrics and Gynecology, University of Copenhagen, Holbæk Hospital, for their assistance with outcome assessment during the study. Edwin Stanton Spencer language edited the article and was paid for the service through project funds.

Presented as a poster and selected for a short oral presentation at the 38th Nordic Congress of Obstetrics and Gynecology hosted by NFOG, June 2012, 16–19, Bergen, Norway.

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

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.