title: Surgical staples compared with subcuticular suture for skin closure after cesarean delivery: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the risk of cesarean wound disruption or infection after closure with surgical staples compared with subcuticular suture.
  
  
  METHODS
  Women with viable pregnancies at 24 weeks of gestation or greater undergoing scheduled or unscheduled cesarean delivery were randomized to wound closure with surgical staples or absorbable suture. Staples were removed at postoperative days 3-4 for low transverse incisions and days 7-10 for vertical incisions. Standardized wound evaluations were performed at discharge (days 3-4) and 4-6 weeks postoperatively. The primary outcome was a composite of wound disruption or infection within 4-6 weeks. Secondary outcomes included operative time, highest pain score on analog scale, cosmesis score, and patient scar satisfaction score. Analyses were by intent to treat.
  
  
  RESULTS
  Of 398 patients, 198 were randomized to staples and 200 to suture (but four received staples). Baseline characteristics including body mass index, prior cesarean delivery, labor, and type of skin incision were similar by group. The primary outcome incidence at hospital discharge was 7.1% for staples and 0.5% for suture (P<.001, relative risk 14.1, 95% confidence interval [CI] 1.9-106). Of 350 (87.9%) with follow-up at 4-6 weeks, the cumulative risk of the primary outcome at 4-6 weeks was 14.5% for staples and 5.9% for suture (P=.008, relative risk 2.5, 95% CI 1.2-5.0). Operative time was longer with suture closure (median time of 58 versus 48 minutes; P<.001). Pain scores at 72-96 hours and at 6 weeks, cosmesis score, and patient satisfaction score did not differ by group.
  
  
  CONCLUSIONS
  Staples closure compared with suture is associated with significantly increased composite wound morbidity after cesarean delivery.
  
  
  BACKGROUND
  : ClinicalTrials.gov, www.clinicaltrials.gov, NCT01008449.
  
  
  METHODS
  : I.
authors.affiliation: Center of Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Figueroa
authors.forename: Victoria Chapman
authors.initials: VC
authors.lastname: Jauk
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Szychowski
authors.forename: Rachel
authors.initials: R
authors.lastname: Garner
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Biggio
authors.forename: William W
authors.initials: WW
authors.lastname: Andrews
authors.forename: John
authors.initials: J
authors.lastname: Hauth
authors.forename: Alan T N
authors.initials: AT
authors.lastname: Tita
mesh_terms: D000328:Adult; D002585:Cesarean Section; D062109:Dermatologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D061646:Operative Time; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D012306:Risk; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult