Abstract
Author(s): Ahmed Mohammed ElMaraghy MD*, Ahmed Nour El-din Hashad MD, Mahmoud Kamel Mohammed Abdelmoula M.B.B.Ch and Aliaa Mohamad Maaty MD
Background: Cesarean delivery (CD) rates have increased during the last few decades, and it has become the most common surgery during women’s reproductive years. The optimal choice of skin closure at cesarean delivery has not yet been determined. The aim of this study is to compare between two different materials used for skin closure at cesarean delivery; glue (Dermabond®; Ethicon, Somerville, NJ) and running subcuticular suture technique using monofilament (Monocryl®; Ethicon). Cosmetic appearance, wound complications and scar healing following cesarean delivery were evaluated.
Patients and methods: Seventy-nine patients undergoing cesarean section under spinal anesthesia were randomized into two groups to receive either Dermabond® glue (2-octyl-cyanoacrylate) or Monocryl® sutures after obtaining informed consent. All patients scheduled for an elective CD for various indications who agreed to participate in the study were included and provided signed informed consent. Postoperatively, the appearance of the scars was evaluated after one week as primary outcome, then they were re-evaluated one month and 6-month later after the CD. The evaluation was made by both the patient and the physician according to a validated scale which is the Patient and Observer Scar Assessment Scale (POSAS). In addition to that, surgical site infection was evaluated using Southampton wound scoring system along with Surgeons’ satisfaction using Surgeons’ satisfaction scale. Other post-operative complications as wound disruption, wound dehiscence (hematoma or seroma) and/or allergy to the material used was also assessed.
Results: The POSAS observer scale was assessed one week after the procedure and despite that there was significant difference between the two groups favoring the glue group at two items of assessment which were the vascularity and thickness with P-value of 0.000 and 0.006 respectively, there was no significant difference between the two groups regarding the overall opinion with P-value of 0.233. Regarding the POSAS patient scale, there was significant difference between the two groups favoring the glue group regarding two items of the assessment scale which are the pain and itching with P-value of 0.000 and 0.007, respectively; however, there was no significant difference between the two groups regarding the overall opinion with P-value of 0.110. There was no statistically significant difference between two groups regarding pre-operative and post-operative hemoglobin with P-value 0.417 and 0.689, respectively. There was highly statistically significant difference in case group than control group regarding the Surgeons’ satisfaction scale with P-value 0.000, the operating time with the material used with P-value 0.000 and the satisfaction with the final closure appearance with P-value 0.000. However, there was no statistically significant difference in the surgical site infection with P-value 0.378. The duration of closure of the skin was with highly significant difference in case group with P-value 0.000. However, there was highly statistically significant difference regarding the cost favoring control group with P-value 0.000.
Conclusion: The Dermabond® glue is relatively an effective, comfortable, and easy method of skin closure after cesarean delivery with low risk for surgical site infection. However, it is not cost effective.
Trial registration: Clinicaltrial.gov Registration number: NCT04371549