SUBCUTICULAR VERSUS INTERRUPTED SKIN CLOSURE AFTER RECURRENT CESAREAN SECTION IN DIABETIC PREGNANT WOMEN AS REGARD SURGICAL SITE INFECTION RATE

Abstract

Cesarean birth is one of the most common laparotomies done in the world today, thus any useful refinement in the operative technique, however minimal, is likely to yield substantial benefits. The surgical technique for cesarean birth has changed from time to time, from surgeon to surgeon and these changes were involved both of the uterine and the skin incisions. 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. Surgical site infection is a common complication of surgery. Infection has always been a feature of modern surgery and continues to be a significant problem for health care practitioners across the world. Surgical site infection is a common and major cause of postoperative morbidity. Its morbidities range from delayed healing to systemic sepsis. Factors known to be associated with poor wound healing include obesity, diabetes mellitus, anemia, malnutrition, choice of suture material and surgical techniques . Although several factors contribute to cesarean wound complications, the ptimal method of skin closure to minimize these complications is unknown. Whereas two large-scale international trials are underway comparing different techniques of cesarean delivery, none is evaluating methods of skin closure. The aim of this study is to determine the surgical site infection rate and patient satisfaction in diabetic patients undergoing cesarean section using subcuticular suture compared to interrupted mattress suture in skin closure. There were 5 RCT comparing subcuticular suture with staples (Frishman et al., 1997), (Gaertner et al., 2008), (Rousseau et al., 2009), (Cromi et al., 2010), (Basha et al., 2010) .Primary outcomes were rates of wound dehiscence (separation) and a composite wound complication rate. Summary 95 Secondary outcomes were patient satisfaction, operating time, and postoperative pain. A total of 877 women from 5 trials were included. Both wound separation (pooled odds ratio, 4.01; P _.0001) and composite wound complication (pooled odds ratio, 2.11; P _ .003) rates were higher with staples. The use of staples reduced operating time (weighted mean difference, - 5.05 minutes; P _ .021). This is a randomized controlled trial conducted in Ain-Shams University Maternity Hospital. It included 140 pregnant women who underwent elective Cesarean section. The patients 'included were any female in childbearing period, planned for elective Cesarean section and diabetc (RBS > 140 mg/dl).