Abstract:

Background: An appropriate suture technique for the closure of the cesarean skin incision is important in preventing hematoma, seroma and surgical site infection that will in turn allow an optimal wound healing. Currently, there is no conclusive evidence on what is the best suture technique for the skin closure by continuous subcuticular suture versus interrupted suture, done at the two university teaching hospitals.

Methods: A randomized equivalence clinical trial involving 380 pregnant women who underwent primary cesarean section was conducted from November 2015 to April 2016. Women were randomized into two groups; either subcuticular continuous suture (Group 1) or interrupted suture skin closure (Group II), each with 190 participants. These women were then followed for 30 days post operatively for the occurrence of hematoma/seroma and surgical site infection (SSI). A comparison of cumulative incidences of SSI and hematoma/seroma in the two groups was done with the equivalence margin of the 95% CI set at ± 5%. If the 95% CI for their difference was within the predefined margin, the two techniques were regarded as equivalent.

Results: The cumulative incidence of SSI in group I was 11.9% (21) whereas group II had 12% (22), with a difference of 0.1% [95% CI -6.8% to 6.5%; p-value = 0.9633]. The cumulative incidence of hematoma/seroma was 9.0 % (16) in group I and 6.0% (11) in group II, with a difference of 3% [95% CI -2.4% to 8.5%; p-value = 0.2754]. Group I had 7 (3.7%) cases with prolonged hospital stay whereas group II had 4 (2.1%) cases with prolonged hospital stay. There was no difference in the length of hospital; stay in the two groups, [95%CI – 1.8 to 4.9; p-value = 0.3587].

Conclusion: The two suture techniques are not equivalent with respect to the incidence of surgical site infections and hematoma/seroma. Subcutaneous continuous suture technique has more incidence of hematoma/seroma than the interrupted suture technique while on the other hand; the two techniques are equivalent in terms of length of hospital stay. As such, more randomized trials are encouraged to determine the superiority or inferiority of either of the two suture techniques with consideration of other additional outcomes of interest e.g. wound pain, wound dehiscence, wound cosmesis etc.