Techniques and materials for skin closure in caesarean section
Abstract
Background
Caesarean section is a common operation with no agreed standard on operative techniques and materials to use. The skin layer can be repaired by sub cuticular stitch immediately below the skin layer, an interrupted stitch or with skin staples. A great variety of materials and techniques are used for skin closure after caesarean section and there is a need to identify which provide the best outcomes for women.
Objectives
To compare the effects of skin closure techniques and materials on maternal outcomes and time taken to perform a caesarean section.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2004). We updated this search on 1 October 2009 and added the results to the awaiting classification section.
Selection criteria
All randomised comparisons of skin closure techniques in caesarean section.
Data collection and analysis
Three papers were identified from the search. Data were extracted independently by two reviewers. On further inspection two were not considered to be randomised controlled trials.
Main results
Only one small randomised controlled trial, involving 66 women, was included in the review. Frishman et al compared staples with absorbable sub‐cuticular suture for closure following caesarean section. While operating time was significantly shorter when using staples, the use of absorbable sub cuticular suture resulted in less postoperative pain and yielded a better cosmetic result at the post‐operative visit.
Authors' conclusions
There is no conclusive evidence about how the skin should be closed after caesarean section. Questions regarding the best closure technique and material and the outcomes associated with each remain unanswered . The appearance and strength of the scar following caesarean section is important to women and the choice of technique and materials should be made by women in consultation with their obstetrician based on the limited information currently available.
[Note: The 14 citations in the awaiting classification section of the review may alter the conclusion of the review once assessed.]
PICOs
Plain language summary
Techniques and materials for skin closure in caesarean section
Best way of closing the mother's skin layer after caesarean section is not known.
When doing a caesarean section, several layers of the mother's abdomen need to be cut to reach the baby. After the baby's birth, the layers need to be closed up again. This review of studies looked at different ways of closing the skin layer. Skin closure can be done with stitches that go under the skin, stitches that go over the skin or staples/clips. There was not enough evidence to say which way gives the least pain or problems for women after caesarean birth.
