Surgical staples compared with subcuticular suture for skin closure after cesarean delivery: A randomized controlled trial

Cesarean delivery is the most common surgical procedure and this prevalence
is on the rise. Given these trends, cesarean wound complications, such as disruption
or infection, remain an important cause of post-cesarean morbidity.
Methods: We conducted a single-center randomized controlled trial that included
women with viable pregnancies (≥24 weeks) undergoing cesarean delivery at Motahary
University Hospital, Urmia, Iran from April to November 2014. All cesarean types
were included: scheduled or unscheduled and primary or repeat cesareans. Women
were excluded for the following reasons: inability to obtain informed consent, immune
compromising disease (e.g. AIDS), chronic steroid use, diabetic mellitus and BMI≥30.
Of 266 women, 133 were randomized to staples and 133 women to suture group.
Results: The mean±SD age of the staples group was 27.6±5.4 years and mean±SD age
of suture was 28.7±5.9 years. Multiparity is the most frequent in both groups that by using
Chi-square test, no significant differences were observed between the two groups
(P=0.393). The most frequent indication for cesarean section in both groups was history
of cesarean section in staple 40 cases (30.1%) and suture 32 cases (24.1%). The survey
was conducted using the Chi-square test was not significant (P=0.381). Pain at 6 weeks
postoperatively was significantly less in the staple group (P=0.001). Operative time was
longer with suture closure (4.68±0.67 versus 1.03±0.07 minute, P<0.001). The Vancouver
scale score was significantly less in suture closure (6.6±0.8 versus 7.5±0.9,
P=0.001). Wound disruption was significantly less in suture closure (3.8% versus
11.3%, P=0.017).
Conclusion: The staple group had low pain and operation time but had a significant
wound disruption and scar. The patients who have suffered a significant wound disruption
were affected by age (P=0.022) and BMI (P=0.001) at compared those who were
not affected by factors such as age or high BMI as risk factors for open surgical wound.