title: Superficial incisional surgical site infection rate after cesarean section in obese women: a randomized controlled trial of subcuticular versus interrupted skin suturing.
abstract: OBJECTIVE
  To compare the superficial incisional surgical site infection (SSI) rate after cesarean section (CS) in obese women using subcuticular versus interrupted skin suturing.
  
  
  METHODS
  The current randomized controlled clinical trial was conducted at Ain Shams University Maternity Hospital. Obese non-diabetic women who underwent elective CS were randomized into two groups: group I included women who had their skin closed with interrupted mattress suture using non-absorbable polypropylene, and group II included women who had their skin closed with subcuticular suture using the same suture material. Primary outcome measure was superficial incisional SSI and secondary outcome measures were skin closure time, postoperative pain assessed by ten-point visual analog scale (VAS) and short-term cosmetic wound outcome according to the Stony Brook Scar Evaluation Scale (SBSES).
  
  
  RESULTS
  A total of 130 obese women were finally analyzed. Group II (n = 67) was associated with higher incidence of superficial incisional SSI. There were nine cases (13.4 %) compared to three cases (4.8 %) in group I (n = 63); however, this difference was statistically not significant (P = 0.088). Skin closure time was significantly prolonged in group I (8.6 ± 2.3 min versus 5.7 ± 2.2 min, respectively, P < 0.001). Postoperative pain was significantly lower in group I and the mean VAS in group I was 4.7 ± 2 versus 5.5 ± 1.8 in group II (P = 0.017). Using SBSES, group II had mean score 4.5 ± 0.7, while group I had mean score 2.7 ± 1.1. This was statistically significant (P < 0.001), which means a better cosmetic outcome in group II.
  
  
  CONCLUSIONS
  Subcuticular skin closure during CS for non-diabetic obese women was significantly associated with better short-term cosmetic outcome, less skin closure time, yet, with slightly higher risk of superficial incisional SSI and significantly more postoperative pain.
authors.affiliation: Department of Obstetrics and Gynecology, Ain Shams University, Building Number 112, El Marwa Tower, Walee EL Ahd Street, Hadayk EL-Kobba, Cairo, Egypt, mi_monem@yahoo.com.
authors.forename: Moustafa I
authors.initials: MI
authors.lastname: Ibrahim
authors.forename: Gamal Farag
authors.initials: GF
authors.lastname: Moustafa
authors.forename: Ahmed Sherif Abd
authors.initials: AS
authors.lastname: Al-Hamid
authors.forename: May Raafat
authors.initials: MR
authors.lastname: Hussein
mesh_terms: D000328:Adult; D002585:Cesarean Section; D062109:Dermatologic Surgical Procedures / Q000379:methods; D004534:Egypt; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D061646:Operative Time; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011247:Pregnancy; D012307:Risk Factors; D016038:Skin Transplantation; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome; D064232:Visual Analog Scale