title: Suture Closure versus Non-Closure of Subcutaneous Fat and Cosmetic Outcome after Cesarean Section: A Randomized Controlled Trial.
abstract: To investigate the effect of subcutaneous fat suture closure versus non-closure at cesarean section (CS) on long-term cosmetic outcome.
  
  
  
  Women undergoing planned or unplanned CS were randomized to either subcutaneous fat suture closure or non-closure using a 1∶1 allocation algorithm. Participants and outcome assessors were blinded to group allocation. Scar evaluation was performed after two and six months. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) summary scores six months after surgery. Secondary outcome measures were Vancouver Scar Scale (VSS) summary scores, retraction of the scar below the level of the surrounding skin, duration of surgery, and development of hematoma, seroma, surgical site infection (SSI) or wound disruption. Data were analyzed according to the intention to treat principle.
  
  
  
  A total of 116 women were randomized and 91 participants, 47 in the closure and 44 in the non-closure group, completed the trial and were analyzed. There were no differences in patient morphometrics or surgery indications between groups. At two and six months no significant differences were found with respect to POSAS or VSS scores between groups. After two months significantly more women in the non-closure group described their scar as being retracted below the level of the skin (36% vs. 15%, p = 0.02) whereas no difference was observed at six months. There were significantly more hematomas in the non-closure (25%) compared to the closure group (4%) (p = 0.005). There was no difference in duration of surgery, SSI, seroma formation or wound disruption between groups.
  
  
  
  Suture closure of the subcutaneous fat at CS does not affect long-term cosmetic outcome. (Level I evidence).
  
  
  
  ClinicalTrials.gov NCT01542346.
authors.affiliation: Department of Obstetrics and Gynecology, Klinikum Klagenfurt am Woerthersee, Feschnigstrasse 11, 9020 Klagenfurt, Austria; Department of Obstetrics and Gynecology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Husslein
authors.affiliation: Department of Obstetrics and Gynecology, Klinikum Klagenfurt am Woerthersee, Feschnigstrasse 11, 9020 Klagenfurt, Austria.
authors.forename: Martina
authors.initials: M
authors.lastname: Gutschi
authors.affiliation: Department of Obstetrics and Gynecology, Klinikum Klagenfurt am Woerthersee, Feschnigstrasse 11, 9020 Klagenfurt, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Leipold
authors.affiliation: Department of Obstetrics and Gynecology, Klinikum Klagenfurt am Woerthersee, Feschnigstrasse 11, 9020 Klagenfurt, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Herbst
authors.affiliation: Department of Obstetrics and Gynecology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Franz
authors.affiliation: Department of Obstetrics and Gynecology, Klinikum Klagenfurt am Woerthersee, Feschnigstrasse 11, 9020 Klagenfurt, Austria.
authors.forename: Christof
authors.initials: C
authors.lastname: Worda
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D011247:Pregnancy; D050151:Subcutaneous Fat / Q000601:surgery*; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult