title: A randomized controlled trial comparing cosmetic outcome after skin closure with 'staples' or 'subcuticular sutures' in emergency cesarean section.
abstract: OBJECTIVE
  To compare staples with subcuticular sutures for skin closure in emergency Cesarean sections (CS).
  
  
  METHODS
  One hundred and thirty women (undergoing emergency CS without previous abdominal delivery) were randomly assigned to either staples or subcuticular skin closure (monocryl 3-0). Primary outcome of the study was cosmetic outcome [as assessed by patient and independent observer: Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS), respectively], 6 weeks post-operative. Secondary outcomes were wound complications, operating time, post-operative pain (visual analogue scale day 3 post-operative and patient assessment of pain in scar 6 weeks post-operative), and duration of hospital stay.
  
  
  RESULTS
  112 women were available for evaluation of scar 6 weeks post-operative. Cosmetic result of staples was significantly better than subcuticular sutures (PSAS and OSAS: p value 0.022 and 0.000, respectively), with significantly lesser duration of surgery (24 vs. 32 min: p value 0.000) and comparable post-operative pain (pain on day 3 and 6 weeks post-operatively: p value 0.474 and 0.179, respectively) and wound complications (p value 0.737). However, duration of stay in hospital was increased (6 vs. 3 days: p value 0.001).
  
  
  CONCLUSIONS
  Staples are the method of choice for skin closure in emergency CS as they are significantly better than subcuticular sutures with respect to cosmesis and duration of surgery. Post-operative pain and wound complications are comparable in two groups. However, staples are associated with significantly increased duration of hospital stay. Trial registered in clinical trial registry CTRI: REF/2013/05/005087.
authors.affiliation: Dr RPGMC Kangra at Tanda (H.P.), Set No. 112, Vivekanand Hostel, Kangra, 176001, HP, India, cdsharma2006@gmail.com.
authors.forename: Chanderdeep
authors.initials: C
authors.lastname: Sharma
authors.forename: Ashok
authors.initials: A
authors.lastname: Verma
authors.forename: Anjali
authors.initials: A
authors.lastname: Soni
authors.forename: Meghna
authors.initials: M
authors.lastname: Thusoo
authors.forename: V K
authors.initials: VK
authors.lastname: Mahajan
authors.forename: Suresh
authors.initials: S
authors.lastname: Verma
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D002921:Cicatrix / Q000473:pathology*; D004954:Esthetics; D005260:Female; D006801:Humans; D007194:India; D007902:Length of Stay / Q000706:statistics & numerical data; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D011247:Pregnancy; D016037:Single-Blind Method; D017792:Surgical Stapling; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques; D064232:Visual Analog Scale; D055815:Young Adult