Non-Suture Skin Closure Technique for Cesarean Section as an Alternative to Usual Methods

INTRODUCTION

Cesarean section (CS) is the most frequent abdominal procedure conducted in women all over the world. A meta-analysis studying the techniques and materials used for skin closure in CS shows no definitive evidence about how the best outcome of the skin closure could be achieved. ¹

Post cesarean section wound complications occur in 5% of women who have undergone CS, which include hematomas, seromas, infection, and pain, that might further lead to wound dehiscence. Obesity or thick subcutaneous tissue (> 3 cm) may have a bad effect on the wound healing. ¹

Staples have similar results regarding wound infection, pain, and cosmetic results when compared to sutures. Both techniques are the most commonly used techniques for skin closure during CS. Staples should not removed before three days post-CS, as this may lead to an increased possibility of skin

separation and the need for re-closure compared to subcuticular sutures. ²

A meta-analysis conducted by Pergialiotis et al. includes ten RCTs involving 3696 women, viewed that the subcutaneous tissue closure technique during CS results in lower wound complications. ³

The trial of a new technique of skin closure could reduce the incidence of wound complications and pain and would have a significant impact on the national economic health plans. ³ So, an introduction of a new non-suture technique for skin closure is being tried.

Aim of the work is to estimate the outcome of non-suture skin closure method of CS wound as an alternative to usual methods.

PATIENTS AND METHODS

This study was a prospective case control study that recruited 100 pregnant women +/- 38 week opting for a caesarean section, at Bab Al-Sharia University Hospital, during the period between January 2021 to June 2021.

This study was divided into two groups:

Group 1: (Steri-strips Group) 50 patients were undergoing non-suture skin closure method for CS wound. The skin was not closed with any suture but was opposed with a pack of steri-strip then the wound was covered with waterproof patch for 14 days, after which, the steri-strips was removed.

Group 2: (Subcuticular Group) 50 patients were undergoing classic skin closure using subcuticular sutures immediately below the skin layer, by an continuous suture, using polypropylene 2-0 (Prolene) sutures.

Inclusion criteria: Patients agreed to be included in the study, patients aged 18 to 35, pregnant Women, Gestational Age +/- 38 weeks, patients opting for elective caesarean section, BMI < 27, patients’ hemoglobin ≥ 10 g/dl, primiparous and multiparous patients, no medical disorders such as DM and/or hypertension, no dermatological diseases such as Psoriasis or Scleroderma, no autoimmune disease affecting wound-healing, and no drug intake affecting wound-healing.

Exclusion criteria: Patients refused to be included in the study, patients suffering from medical disorders affecting wound-healing, eg. DM, patients suffering from dermatological diseases, patients suffering from autoimmune diseases eg. SLE, BMI > 27, patient’s haemoglobin < 10 g/dl, patients requiring urgent CS eg. obstructed labour, cord prolapse, malpresentations, placenta previa, and obstetric disorders eg. gestational DM, gestational HTN, PE, obstetric cholestasis.

The study was presented for approval from ethical committee of the Department of the Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University

All cases were subjected to the following:

Consent: all participants in the study were received both oral and written informed consent after explaining the details of the study for them, as agreed upon by the ethical committee.

Full history-taking.

General examination: BP, Pulse, RR, Temperature, BMI.

Abdominal examination.

Ultrasound for assessment and follow up.

Routine investigation in the form of complete blood count, coagulation profile, liver function tests and kidney function tests was done.

Statistical analysis:

Statistical presentation and analysis of the present study was conducted, using the mean, standard deviation, unpaired student t-test was used to compare between two groups in quantitative data and chi-square test was used to compare between groups in qualitative by (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). P value < 0.05 was considered significant.

RESULTS

Table 1: Comparison between two groups as regarded cosmotic day 14, cosmotic 3 month, surgical site infection day 14, and Seroma day 14.

There was statistically significant between two groups as regarded cosmotic day 14 when p-value was <0.05*. There was statistically significant between two groups as regarded cosmotic 3month when p-value was <0.05*. There was statistically significant between two groups as regarded Surgical site infection day 14when p-value was <0.05*. There was statistically significant between two groups as regarded seroma day 14 when p-value was <0.05* (Table 1).

Table 2: Comparison between two groups as regarded hematoma day 14, and keloid 3 months.

There was statistically significant between two groups as regarded hematoma day 14 when p-value was <0.05*. There was statistically significant between two groups as regarded keloid 3month when p-value was <0.05* (Table 2).

Table 3: Comparison between two groups as regarded age, BMI and Hb.

There were non-statistically significant between two groups as regarded age, BMI, and Hb when p-value was >0.05 (Table 3).

Table 4: Comparison between two groups as regarded pain.

There was highly statistically significant between two groups as regarded pain when p-value was <0.001** (Table 4).