title: Subcutaneous tissue reapproximation, alone or in combination with drain, in obese women undergoing cesarean delivery.
abstract: OBJECTIVE
  To compare the efficacy of subcutaneous suture reapproximation alone with suture plus subcutaneous drain for the prevention of wound complications in obese women undergoing cesarean delivery.
  
  
  METHODS
  We conducted a multicenter randomized trial of women undergoing cesarean delivery. Consenting women with 4 cm or more of subcutaneous thickness were randomized to either subcutaneous suture closure alone (n = 149) or suture plus drain (n = 131). The drain was attached to bulb suction and removed at 72 hours or earlier if output was less than 30 mL/24 h. The primary study outcome was a composite wound morbidity rate (defined by any of the following: subcutaneous tissue dehiscence, seroma, hematoma, abscess, or fascial dehiscence).
  
  
  RESULTS
  From April 2001 to July 2004, a total of 280 women were enrolled. Ninety-five percent of women (268/280) had a follow-up wound assessment. Both groups were similar with respect to age, race, parity, weight, cesarean indication, diabetes, steroid/antibiotic use, chorioamnionitis, and subcutaneous thickness. The composite wound morbidity rate was 17.4% (25/144) in the suture group and 22.7% (28/124) in the suture plus drain group (relative risk 1.3, 95% confidence interval 0.8-2.1). Individual wound complication rates, including subcutaneous dehiscence (15.3% versus 21.8%), seroma (9.0% versus 10.6%), hematoma (2.2% versus 2.4%), abscess (0.7% versus 3.3%), fascial dehiscence (1.4% versus 1.7%), and hospital readmission for wound complications (3.5% versus 6.6%), were similar (P > .05) between women treated with suture alone and those treated with suture plus drain, respectively.
  
  
  CONCLUSIONS
  The additional use of a subcutaneous drain along with a standard subcutaneous suture reapproximation technique is not effective for the prevention of wound complications in obese women undergoing cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Center for Research in Women's Health, University of Alabama at Birmingham, USA. ramsey_patrick@hotmail.com
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Ramsey
authors.forename: Anna M
authors.initials: AM
authors.lastname: White
authors.forename: Debra A
authors.initials: DA
authors.lastname: Guinn
authors.forename: George C
authors.initials: GC
authors.lastname: Lu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ramin
authors.forename: Jill K
authors.initials: JK
authors.lastname: Davies
authors.forename: Cherry L
authors.initials: CL
authors.lastname: Neely
authors.forename: Crystal
authors.initials: C
authors.lastname: Newby
authors.forename: Linda
authors.initials: L
authors.lastname: Fonseca
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Case
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kaslow
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: John C
authors.initials: JC
authors.lastname: Hauth
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D016001:Confidence Intervals; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009765:Obesity / Q000150:complications / Q000175:diagnosis*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000517:prevention & control; D011247:Pregnancy; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D040521:Subcutaneous Tissue / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology