Research
Obstetrics
Cosmetic outcomes of various skin closure methods following cesarean delivery: a randomized trial

https://doi.org/10.1016/j.ajog.2010.02.001Get rights and content

Objective

The objective of the study was to compare scar quality associated with different types of wound closure methods after cesarean section (CS).

Study Design

Patients were randomized to have skin closure following CS with either staples or 3 different types of subcuticular sutures. Scar quality was evaluated 2 and 6 months postoperatively. The Vancouver Scar Scale, the Patient and Observer Scar Assessment Scale (POSAS), and a visual analog scale were used as scar assessment tools.

Results

Of the 180 patients who were recruited, 123 successfully completed the study. No difference in both subjective and objective scar rating was detected across groups at either 2 months or 6 months. In the overall study population, objective scores correlated with patient rating, and correlation was strongest between the observer and patient components of the POSAS (r = 0.48).

Conclusion

In women undergoing CS, stapled wounds and those closed with subcuticular sutures result in equivalent cosmetic appearance of the scar.

Section snippets

Materials and Methods

A single-institution, randomized, multidisciplinary clinical trial was designed to compare healing outcomes of Pfannenstiel incision after cesarean delivery using different skin closure methods. Between October 2006–March 2008, women undergoing cesarean section for any indication who were at least 18 years old and literate in Italian language were offered participation in the study.

Exclusion criteria included history of keloids, previous transversal suprapubic scars, tattoos in the area to be

Results

Of the 494 women undergoing cesarean delivery during the study interval, 271 did not meet the inclusion criteria, and 43, who were potentially eligible, declined to participate in the study protocol. A total of 180 patients were randomized and allocated to 4 intervention groups. Flow of participants through each stage of the randomized clinical trial is displayed in Figure 3. One hundred fifty-nine patients (88.3%) had an initial follow-up, and 123 subjects (68.3%) successfully completed the

Comment

The results of this study indicate that cesarean section wounds closed by all 4 methods (staples or subcuticular sutures with different material) had similar cosmesis at 2 and 6 months postpartum.

Three previous randomized trials, which evaluated wound cosmesis of Pfannenstiel incision in women undergoing cesarean section, who were randomly assigned to subcuticular sutures or staples, yielded conflicting results. Frishman et al7 showed that cosmetic outcome (using a 4-category scale, from

References (20)

There are more references available in the full text version of this article.

Cited by (0)

Cite this article as: Cromi A, Ghezzi F, Gottardi A, et al. Cosmetic outcomes of various skin closure methods following cesarean delivery: a randomized trial. Am J Obstet Gynecol 2010;203:36.e1-8.

View full text