Adhesive Glue vs Subcuticular Sutures for Cesarean Section Skin Closure: A Double Blind Randomized Controlled Trial

Abstract

Objectives: The objectives of the study were to compare the wound complication rate, postoperative pain and overall patient satisfaction between adhesive glue and subcuticular suture in women undergoing elective Caesarean Section (CS). Methods: A double blind Randomized Controlled trial was conducted among pregnant women undergoing an elective CS, who were randomly assigned to skin closure with adhesive glue or with a Polyglactin 3-0 subcuticular suture. In both groups after closure of the rectus fascia, the subcutaneous fat layer was closed with 3-4 interrupted catgut or Vicryl 1-0. In the adhesive glue group, 2 layers of adhesive glue were used to close the outer skin layer. In the suture group, the skin was closed with Polyglactin 3-0 suture under the skin using a continuous suture technique. A sample of 52 in each group was needed to achieve any significant finding with a power of 80%. Primary outcome assessed were parenteral analgesic use, daily subjective pain scores while in hospital, 6 week postoperative subjective pain score and scar cosmetic score 6 weeks post-operatively. Secondary outcome assessed were surgeons satisfaction, duration of surgery, duration of hospitalization after the caesarean, and wound complications. Results: Two hundred pregnant women at term for elective caesarean were assessed for eligibility of which 132 fulfilled the criteria and were randomized into two groups. Sixty women in each group completed the required follow up. Pa-tients’ baseline demographic and clinical backgrounds were similar in both the groups. Postoperative day 3 subjective pain score was significantly lower in adhesive glue group (p=0.023) compared to suture group. Skin closure time with glue required less time compared to suture (glue 2.57±.67 minute vs suture 3.2±1.18 minute, p=0.001). Total operative time was also less in adhesive glue group though the difference was not significant (39.52±8.24 minute vs 42.1±6.10, p=0.054). Scar assessment by the modified patient and observer scar assessment scale (POSAS) at 6 weeks postpartum showed similar cosmetic outcome between the two groups. Patient Scar cosmetic score was 11.8 for glue group and 12.7 for suture group (p=0.330) while the Observer Scar cosmetic score was 10.8 for glue group and 11.7 for suture (p=0.252). No significant differences were observed between the groups in blood loss, surgical site infection, length of hospitalization, or wound breakdown. Conclusion: Adhesive glue may be a useful option for skin closure of Pfannenstiel skin incisions after caesarean deliv-ery. It has the advantages like shorter skin closure and operating time, less postoperative pain and similar cosmesis and satisfaction among surgeons with no increases in wound complication rates.