Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery


      The purpose of this study was to determine the wound complication rates and patient satisfaction for subcuticular suture vs staples for skin closure at cesarean delivery.

      Study Design

      This was a randomized prospective trial. Subjects who underwent cesarean delivery were assigned randomly to stainless steel staples or subcuticular 4.0 Monocryl sutures. The primary outcomes were composite wound complication rate and patient satisfaction.


      A total of 435 patients were assigned randomly. Staple closure was associated with a 4-fold increased risk of wound separation (adjusted odds ratio [aOR], 4.66; 95% confidence interval [CI], 2.07–10.52; P < .001). Having a wound complication was associated with a 5-fold decrease in patient satisfaction (aOR, 0.18; 95% CI, 0.09–0.37; P < .001). After confounders were controlled for, there was no difference in satisfaction between the treatment groups (aOR, 0.71; 95% CI, 0.34–1.50; P = .63).


      Use of staples for cesarean delivery closure is associated with an increased risk of wound complications. Occurrence of a wound complication is the most important factor that influenced patient satisfaction.

      Key words

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      Linked Article

      • Implications of early staples removal at cesarean delivery
        American Journal of Obstetrics & GynecologyVol. 205Issue 5
        • Preview
          We read with great interest the randomized controlled trial accessing wound complication rates of subcuticular suture and staples for skin closure at cesarean delivery, reported by Basha et al.1 This study brought new discussion in what concerns skin closure at cesarean delivery.1,2 The authors showed that women whose skin incisions were closed with staples were more likely to have a wound separation than women whose incisions were closed with 4-0 Monocryl (Ethicon, Juarez, Mexico) subcuticular sutures, even after adjustment for potential confounders.
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      • Skin closure at cesarean section
        American Journal of Obstetrics & GynecologyVol. 205Issue 1
        • Preview
          I read with interest the article by Basha et al.1 Their manuscript has significant implication for patient care and clinical practice; however, absence of the following details questions the validity of their findings.In the article, which addresses mainly wound closure, it is important that readers are made aware of these issues.
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