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Abstract

We appreciate the opportunity to respond to the comments about our study, “Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery.”1Basha S.L. Rochon M.L. Quiñones J.N. et al.Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery.Am J Obstet Gynecol. 2010; 203: 285-287Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar Although much of the requested information is contained in the full-length version of the article, we want to highlight the important issues related to the comments. As we have reported, the most significant wound complication identified was wound separation. Therefore, we limited our more detailed analyses of wound complications to the outcome of actual wound separation.1The unadjusted odds ratio for wound separation was 3.67 (95% confidence interval, 1.86–7.25) for staples. A multivariate analysis was performed controlling for both chorioamnionitis and previous cesarean, as well as obstetrician, gestational age at delivery, body mass index, any maternal comorbidity, any diabetes mellitus, any hypertension, cesarean delivery in labor, emergent cesarean delivery, non-Pfannenstiel incision, and operative time >90 minutes. The adjusted odds ratio for wound separation was 4.13 (95% confidence interval, 1.87–9.11) for staples.2In the staples group, 78% (153/197) had their staples removed on postoperative day 3 or 4 prior to hospital discharge. Of the 33 women in the staples group with a wound separation, 58% (19) had staples removed on day 3 and 15% (5) on day 4. The remaining 27% (9) had their staples removed after discharge. While we agree that skin approximation technique is important, we did not specifically examine the impact of day of staple removal on wound complications for the subset of women with previous abdominal surgical scars.3There were no significant differences in body mass index >30 kg/m2 (suture 59%, staples 65%, P = .29) or length of stay (3.1 ± 0.5 days for suture and 3.2 ± 0.6 days for staples, P = .15). In the entire study population, only 1 patient from the staples arm did not receive prophylactic antibiotics. In summary, we believe that our results are not only valid, but robust. We agree that our findings have significant implications for patient care and clinical practice, although they may be in conflict with individual physicians' personal biases as to optimal closure technique. Therefore, we welcome continued discussion and would be interested in seeing the results of other studies that investigate whether particular variations in technique of suture or staple management have an effect on wound complication rates. Skin closure at cesarean sectionAmerican Journal of Obstetrics & GynecologyVol. 205Issue 1PreviewI 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. Full-Text PDF