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 STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (August 2002). 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. REVIEWER'S 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.