Subcutaneous tissue reapproximation, alone or in combination with drain, in obese women undergoing cesarean delivery.
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.
Ramsey
Patrick S
PS
Department of Obstetrics and Gynecology, Center for Research in Women's Health, University of Alabama at Birmingham, USA. ramsey_patrick@hotmail.com
White
Anna M
AM
Guinn
Debra A
DA
Lu
George C
GC
Ramin
Susan M
SM
Davies
Jill K
JK
Neely
Cherry L
CL
Newby
Crystal
C
Fonseca
Linda
L
Case
Ashley S
AS
Kaslow
Richard A
RA
Kirby
Russell S
RS
Rouse
Dwight J
DJ
Hauth
John C
JC
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