title: Closure of the subcutaneous dead space and wound disruption after Cesarean delivery.
abstract: OBJECTIVE
  To determine whether suture closure of subcutaneous dead space decreases wound disruption after Cesarean delivery.
  
  
  METHODS
  All patients undergoing Cesarean delivery at the New England Medical Center from September 1995 to June 1997 were eligible. One group (162 patients) was randomly assigned to have the subcutaneous fat layer closed with a running 3-0 plain suture. The other group (165 patients) had this layer left unclosed. Both groups had careful hemostasis of this layer with cautery and copious irrigation. All laboring and ruptured patients received prophylactic antibiotics. The patients were followed for 6 weeks after delivery for wound disruption.
  
  
  RESULTS
  No significant differences were noted between the two groups with respect to demographic, obstetric, or surgical characteristics or loss to follow-up. Excluding those lost to follow-up (27 closed vs. 22 unclosed), there was no difference in wound infection (11 (8.1%) closed vs. 13 (9.1%) unclosed, RR 0.90, 95% CI 0.14, 2.08). There were decreases in risk of skin separation (three (2.2%) vs. six (4.2%), RR 0.53, 95% CI 0.42, 1.93) and seroma or hematoma formation (two (1.5%) vs. seven (4.9%), RR 0.30, 95% CI 0.06, 1.43) that were not statistically significant. Decreases that were not statistically significant were also noted for any wound disruption (14 (10.4%) vs. 21 (14.7%), RR 0.71, 95% CI 0.37, 1.33) and non-infected wound complication (three (2.2%) vs. eight (5.6%), RR 0.40, 95% CI 0.11, 1.47). Increasing gravidity and parity, and Cesarean delivery performed for failure to progress were independent risk factors for any wound complication. Controlling for these factors did not alter the effect of subcutaneous closure.
  
  
  CONCLUSIONS
  Closure of the subcutaneous space does not increase and may protect against wound complications in patients undergoing Cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
authors.forename: D
authors.initials: D
authors.lastname: Chelmow
authors.forename: E
authors.initials: E
authors.lastname: Huang
authors.forename: K
authors.initials: K
authors.lastname: Strohbehn
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D040521:Subcutaneous Tissue / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology*; D013536:Suture Techniques / Q000009:adverse effects*; D016896:Treatment Outcome