From Stitch to Success: Study assessed on Wound Closure Methods in Elective Cesarean Deliveries
Recently published randomized controlled trial assessed the efficacy and safety of three wound closure approaches-subcutaneous suture reapproximation alone, suture combined with a subcutaneous drain, and non-closure—in preventing wound complications in obese women undergoing elective cesarean delivery (CD). The study targeted a demographic known for higher risk factors, as obesity is associated with increased likelihood of surgical site infections (SSI) and other complications.
Trial Details
Conducted at Kasr Alainy Maternity Hospital, the trial involved 352 obese women (BMI ≥ 30 kg/m²) aged between 25 and 35 years. Participants were randomized into four groups: 89 with sutures and a drain, 88 with sutures only, 88 with a drain only, and 87 with no closure. All subjects received prophylactic antibiotics before surgery. Key parameters assessed included postoperative pain, fever, wound complications such as seroma, infection, and dehiscence.
Results Summary
Results showed that women who underwent combined suturing and drain placement experienced significantly lower postoperative pain scores and fever. Inversely, patients in the non-closure group exhibited the highest rates of complications, with notable increases in seromas, infections, dehiscence, and the need for wound redressing. The data illustrate that combined suturing and drainage reduces wound complication incidences, establishing it as a superior method for wound management in this high-risk population. Statistical analysis indicated significant differences across groups concerning postoperative pain, fever, wound infection rates, and dehiscence. The duration of surgery was found to be longest in the group receiving both sutures and drains. Though the added procedure time was significant, it did not clinically outweigh the benefits in wound care.
Implications and Limitations
The study reaffirms previous literature suggesting closures in the subcutaneous layer reduce complications, offering a novel combination approach that further minimizes postoperative risks. Despite limitations, such as a short follow-up period of two weeks and potential subjective bias due to lack of participant blinding, findings advocate for the routine assessment and consideration of these techniques in clinical practice. Economic evaluations and individual area-based assessments are recommended for the application of these techniques to ensure resource efficiency and optimal patient outcomes.
Impact on Surgical Protocols
These results can fundamentally influence surgical protocols for managing obese patients undergoing CD, emphasizing the essential role that wound management plays in improving patient care and outcomes.
Key Points
- A randomized controlled trial evaluated the effects of three wound closure methods in preventing complications in 352 obese women undergoing elective cesarean delivery, focusing on subcutaneous suture reapproximation alone, suture plus a subcutaneous drain, and non-closure.
- Participants were aged 25 to 35 with a Body Mass Index (BMI) of 30 kg/m² or higher, and were randomized into four groups: 89 participants receiving sutures and a drain, 88 receiving sutures only, 88 receiving a drain only, and 87 receiving no closure, with all women receiving prophylactic antibiotics before surgery.
- Findings indicated that the group receiving combined suturing and drain placement experienced significantly reduced postoperative pain scores and fever, whereas the non-closure group showed the highest complication rates, including increased seromas, infections, dehiscence, and additional wound redressing.
- Statistical analyses demonstrated significant differences in postoperative pain, fever, wound infection rates, and dehiscence across groups, with the longest surgical duration noted in the combined sutures and drain group; however, the clinical benefits outweighed the longer procedure time.
- The study supports the notion that closures in the subcutaneous layer reduce complications and introduces a combination technique that further diminishes postoperative risks, although limitations include a two-week follow-up period and potential subjective bias due to lack of blinding.
- The findings advocate for revised surgical protocols for wound management in obese patients undergoing cesarean delivery, underscoring the importance of effective wound care strategies in enhancing patient outcomes and suggesting the need for economic evaluations for resource efficiency.
Reference –
Mohamed A Shalaby et al. (2025). The Value Of Subcutaneous Tissue Closure And Drain In Obese Women Undergo Elective Caesarean Section: A Randomized Controlled Trial. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07579-z.
