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Saturday, May 17, 2014

Trailers (83): Suture or staples for skin closure at cesarean delivery?

Mackeen et al. Suture compared with staple skin closure after cesarean delivery: a randomized controlled trial.

Why should you read about this topic?

Post-cesarean wound complications interfere with mother-infant interactions.  We need to know what to do to reduce the incidence of those infections.

What were the authors trying to do?

Compare the incidence of wound complications between suture and staple skin closure after cesarean delivery

Who participated and in what setting?

Women (N=746) undergoing cesarean delivery with a transverse skin incision at 3 hospitals in the Northeastern US between 2010 and 2012

What was the study design?

Randomized trial of continuous subcuticular suture or staples for skin closure at cesarean delivery

What were the main outcome measures?

Composite wound complication outcome (infection, hematoma, seroma, significant separation, or readmission for wound complications.

What were the results?

Women with suture closure had a lower wound complication rate (4.9%) than women with staples closure (10.6%), largely due to wound separation.  Skin closure with suture took 9 minutes longer than closure with staples

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths: randomized trial; pre-specified subgroup analysis; screening for enrollment bias. Weaknesses: outcomes determined by provider, not study personnel

What does the study contribute for your practice?

If you have the extra time at cesarean delivery, skin closure with subcuticular sutures yields fewer wound complications