Skin Closure of Pfannenstiel Incision with Dermabond, Staples, or Suture during Cesarean Delivery: Experience of a Single Attending

Abstract

Objective We aimed to compare the rates of wound separation (WS) and surgical site infection (SSI) after cesarean delivery (CD) by a single surgeon. Pfannenstiel skin incision (PSI) was closed with Dermabond, staples, or suture.

Study Design Retrospectively all women having CD via PSI were identified. WS and SSI rates with Dermabond were compared with other two techniques.

Results Of 239 CDs performed, 88% (n = 211) were available for postpartum evaluation. The PSI was closed with Dermabond in 85 (40%), staples in 76 (36%), and suture in 50 (24%). Overall WS rate was 7%; with Dermabond, it was 5% versus 13% with staple (p = 0.090) and 2% with suture (p = 0.651). Post hoc calculation suggests a randomization of 4325 women is needed to determine if Dermabond has one-third less wound complication than suture.

Conclusion For the PSI closure, Dermabond may be a useful alternative skin closure device, though a randomized trial is warranted.

Keywords

skin closure - Dermabond - staples - suture - cesarean delivery

Notes

Presented at the 78th Central Association of Obstetricians and Gynecologists (CAOG) Annual Meeting, October 26 to 29, 2011, Nassau, Bahamas.

• References

• 1 Toriumi DM, Bagal AA. Office-based procedures in facial plastic surgery. Otolaryngol Clin North Am 2002; 35: 103-118
• 2 Singer AJ, Quinn JV, Clark RE, Hollander JE. TraumaSeal Study Group. Closure of lacerations and incisions with octylcyanoacrylate: a multicenter randomized controlled trial. Surgery 2002; 131: 270-276
• 3 Toriumi DM, O'Grady K, Desai D, Bagal A. Use of octyl-2-cyanoacrylate for skin closure in facial plastic surgery. Plast Reconstr Surg 1998; 102: 2209-2219
• 4 Quinn J, Wells G, Sutcliffe T , et al. A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations. JAMA 1997; 277: 1527-1530
• 5 Burns TB, Worthington JM. Using tissue adhesive for wound repair. A practical guide to Dermabond. Am Fam Physician 2000; 1: 1383-1388
• 6 Greene D, Koch RJ, Goode RL. Efficacy of octyl-2-cyanoacrylate tissue glue in blepharoplasty. A prospective controlled study of wound-healing characteristics. Arch Facial Plast Surg 1999; 1: 292-296
• 7 Farion K, Russell KF, Osmond MH, Hartling L, Klassen TP, Durec T, Vandermeer B. Tissue adhesives for traumatic lacerations in children and adults. Cochrane Database Syst Rev 2001, Issue 4
• 8 Switzer EF, Dinsmore RC, North Jr JH. Subcuticular closure versus Dermabond: a prospective randomized trial. Am Surg 2003; 69: 434-436
• 9 Matin SF. Prospective randomized trial of skin adhesive versus sutures for closure of 217 laparoscopic port-site incisions. J Am Coll Surg 2003; 196: 845-853
• 10 Ridgway DM, Mahmood F, Moore L, Bramley D, Moore PJ. A blinded, randomised, controlled trial of stapled versus tissue glue closure of neck surgery incisions. Ann R Coll Surg Engl 2007; 89: 242-246
• 11 Ong J, Ho KS, Chew MH, Eu KW. Prospective randomised study to evaluate the use of DERMABOND ProPen (2-octylcyanoacrylate) in the closure of abdominal wounds versus closure with skin staples in patients undergoing elective colectomy. Int J Colorectal Dis 2010; 25: 899-905
• 12 Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized controlled trial. Am J Obstet Gynecol 2007; 196: 455.e1-455.e5
• 13 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jrarvis WR. Guidelines for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20: 250-280
• 14 National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32: 470-485
• 15 Duff P. A simple checklist for preventing major complications associated with cesarean delivery. Obstet Gynecol 2010; 116: 1393-1396
• 16 Tuuli MG, Rampersad RM, Carbone JF, Stamilio D, Macones GA, Odibo AO. Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol 2011; 117: 682-690
• 17 Bruns TB, Worthington JM. Using tissue adhesive for wound repair: a practical guide to dermabond. Am Fam Physician 2000; 61: 1383-1388
• 18 Pearson AS, Wolford RW. Management of skin trauma. Prim Care 2000; 27: 475-492
• 19 Coulthard P, Esposito M, Worthington HV, van der Elst M, van Waes OJ, Darcey J. Tissue adhesives for closure of surgical incisions. Cochrane Database Syst Rev 2010; (5) CD004287
• 20 Blondeel PN, Murphy JW, Debrosse D , et al. Closure of long surgical incisions with a new formulation of 2-octylcyanoacrylate tissue adhesive versus commercially available methods. Am J Surg 2004; 188: 307-313
• 21 Basha SL, Rochon ML, Quiñones JN, Coassolo KM, Rust OA, Smulian JC. Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. Am J Obstet Gynecol 2010; 203: 285.e1-285.e8