Subcutaneous tissue approximation in relation to wound disruption after cesarean delivery in obese women.
OBJECTIVE
To test the hypothesis that closure of the subcutaneous fat decreases the incidence of wound disruption after cesarean delivery.


METHODS
Two hundred forty-five women with at least 2 cm of subcutaneous fat were randomized to closure of the Camper fascia or no closure with cesarean delivery.


RESULTS
Complications leading to disruption or opening of the incision were classified as wound seromas in 28 women (11.4%) and as wound infections in 17 (7.0%). The relative risk (RR) of seroma formation in the subcutaneous closure group was 0.3 with a 95% confidence interval (CI) of 0.1-0.7 (5.1 versus 17.2%), a statistically significant difference. There was no significant difference in the incidence of wound infections in the two study groups. Overall, there was a significant difference in the incidence of wound disruption from all causes between the two groups: 14.5% in the subcutaneous closure group compared with 26.6% when the subcutaneous tissues were not reapproximated (RR 0.5, 95% CI = 0.3-0.9).


CONCLUSIONS
Closure of the subcutaneous tissue can significantly reduce the rate of postoperative wound disruption in women with at least 2 cm of subcutaneous adipose tissue.
Naumann
R W
RW
Department of Obstetrics and Gynecology, University of Alabama at Birmingham.
Hauth
J C
JC
Owen
J
J
Hodgkins
P M
PM
Lincoln
T
T
D000328:Adult; D000704:Analysis of Variance; D002585:Cesarean Section / Q000379:methods*; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000517:prevention & control*; D013536:Suture Techniques