Study compares suture types for skin closure in cesarean delivery

Jan 23 2017

In a study to be presented Thursday, Jan. 26, in the oral concurrent session at 1:15 p.m. PST, at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting™, researchers with the Albert Einstein College of Medicine/Montefiore Medical Center in Bronx, New York, will present their findings in a study titled, Comparison of subcuticular suture type in post-cesarean wound complications: a randomized controlled trial. In the study researchers tested two types of sutures--poliglecaprone 25 (monocryl® suture) and polyglactin 910 (vicryl® suture). Monocryl is an absorbable, single filament suture with low tissue reactivity which dissolves slowly and loses strength. Vicryl is an absorbable, braided suture with low tissue reactivity which dissolves quickly but maintains strength.

Over the course of 14 months, 550 patients were randomized with 275 receiving monocryl suture and 275 receiving vicryl. Patients studied were those undergoing non-emergency cesarean deliveries at 37 weeks gestation or longer and there was no significant difference in demographic information (age, body mass index, ethnicity, gestational age, gravidity, parity) between the two study groups. Patients were followed for complications until their six-week postpartum visit. The primary outcome was wound complications within the first 30 days following delivery. Complications included the incision reopening, hematoma, swelling, fluid gathering around the incision and/or infection.

Arin Buresch, M.D., with Albert Einstein College of Medicine and the presenter of the study at the SMFM annual meeting, said, "We found that monocryl suture had a significantly decreased rate of wound complications compared to the vicryl suture." She went on to explain, "The difference in wound complications may occur due to the braiding in vicryl suture which conceivably allows bacterial growth in small nooks and crevices. In the future, we hope our study will help guide the decision-making on which suture type is used when closing the skin in cesarean births."

OBJECTIVE: To compare poliglecaprone 25 (Monocryl) and polyglactin 910 (coated Vicryl) for cesarean incision closure to determine rates of wound complication.

STUDY DESIGN: Patients undergoing non-emergent cesarean delivery > 37 weeks of gestation were randomized to receive poliglecaprone 25 or polyglactin 910 for subcuticular skin closure of Pfannenstiel incisions. The primary outcome was wound complication within the first 30 days postpartum. Wound complication was defined as wound separation of > 1 cm in length, hematoma or seroma (at least moderate serous fluid collection or subcutaneous blood collection), and surgical site infection as defined by the Centers for Disease Control and Prevention. Standard statistical methods were employed.

RESULTS: In 14 months, 383 patients were randomized; poliglecaprone (n=192) and polyglactin (n=191). Poliglecaprone (n=186) and polyglactin (n=175) patients completed 30-day follow-up. There was no significant difference found in demographic information (age, BMI, ethnicity, gestational age, gravidity, parity) between study groups. The overall cohort composite wound complication rate was 10.0% (n=36). The composite wound complication rate for poliglecaprone vs. polyglactin was 6.5% vs. 13.7%, respectively (p=.02). The overall rate of surgical site infection was 6.7% (n=24) with 4.3% in the poliglecaprone group compared to 9.1% in the polyglactin group (p=.09).

CONCLUSION: In this first randomized controlled trial in the literature specifically focused on the use of absorbable suture for abdominal wound closure at cesarean, we found that polyglactin suture significantly increases risk for wound complications when compared to poliglecaprone suture in a large, diverse, and high risk population. We believe the use of poliglecaprone resulted in fewer wound complications because it is a monofilament suture with a longer absorption time.

Source: https://www.smfm.org