Skin closure at cesarean delivery, glue vs subcuticular sutures: a randomized controlled trial.
BACKGROUND
The optimal choice of skin closure at cesarean delivery has not yet been determined.


OBJECTIVE
This study compared wound complications and scar healing following cesarean delivery between 2 methods of skin closure: glue (Dermabond; Ethicon, Somerville, NJ) and monofilament (Monocryl; Ethicon) epidermal sutures.


METHODS
We conducted a randomized controlled trial in which pregnant women undergoing a scheduled cesarean delivery were randomly assigned to skin (epidermis) closure with glue or with a monofilament synthetic suture. The subcutaneous tissue was sutured for all patients. Outcome assessors were blinded to group allocation. Scars were evaluated >8 weeks. Primary outcome measures were Patient and Observer Scar Assessment Scale scores. Secondary outcome measures were surgeon satisfaction, duration of surgery, duration of hospitalization after the cesarean delivery, and complications of surgical site infection or wound disruption (hematoma or seroma). A sample of 104 women was needed to achieve a clinically significant effect with a power of 80%.


RESULTS
Demographic characteristics, patients' clinical background, prepregnancy body mass index, and subcutaneous thickness were similar in both groups. Length of surgery between the groups (37 ± 10 minutes for glue vs 39 ± 13 minutes for sutures, P = .515) was similar. Scores immediately after the wound closure were similar for both groups regarding surgeons' time estimate of closure (P = .181) and closure appearance (P = .082). Surgeons' satisfaction with the technique was significantly higher in the suture group (P = .003). No significant differences were found between the groups in blood loss, surgical site infection, length of postpartum hospitalization, or wound disruption. Glue and suture skin closure scores using Patient and Observer Scar Assessment Scale were similar 8 weeks after surgery, at P = .710 for patients and P = .568 for a physician observer.


CONCLUSIONS
Skin closure using glue or a monofilament synthetic suture had similar results. Both methods were shown to be safe and successful for skin closure after a scheduled cesarean delivery and, therefore, can be used based on surgeon and patient preferences.
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: yair.dykan@gmail.com.
Yair
Y
Daykan
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Maya
M
Sharon-Weiner
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Yael
Y
Pasternak
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Keren
K
Tzadikevitch-Geffen
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ofer
O
Markovitch
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Genetics Institute, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Rivka
R
Sukenik-Halevy
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Tal
T
Biron-Shental
D000328:Adult; D001291:Attitude of Health Personnel; D002585:Cesarean Section; D003487:Cyanoacrylates; D005260:Female; D006801:Humans; D011247:Pregnancy; D066231:Surgeons; D013537:Sutures; D014014:Tissue Adhesives; D014945:Wound Healing
D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate