Skin Closure Materials Research Articles

Orthopedic Skin Closure in South India: Sutures Versus Staples and Their Postoperative Outcomes.

Introduction Skin closure is an essential step in deciding the success of a surgery. Despite this, the choice of skin closure material is frequently overlooked when making surgical decisions. Skin closure plays an important role in promoting rapid wound healing and decreasing the length of hospital stay, especially in orthopedic surgeries. Our study focused on comparing the outcome of wound closure in orthopedic surgeries with sutures and staples in a South Indian population. Materials and methods We enrolled 120 patients undergoing orthopedic procedures at Chettinad Hospital and Research Institute from July 2023 to February 2024. Patients were randomly assigned to skin closure with either staples or sutures. Wound inspection was done on the 2nd, 5th, 7th and 12th post-operative days. The patients were evaluated at six months using the Visual Analog Scale (VAS) and Hollander Wound Evaluation Score (HWES). Results Staple closure significantly reduced mean closure time (5.2 ± 0.9 minutes) compared to sutures (12.6 ± 1.5 minutes, p < 0.0001). Pain during staple removal was less (VAS score 1.41 ± 0.15) than with suture removal (VAS score 1.57 ± 0.2, p = 0.024). Although patient satisfaction was similar between the groups (Staples: 8.35 ± 0.45 vs. Sutures: 8.0 ± 0.5, p = 0.062), staples provided superior cosmetic outcomes (HWES: 4.1 ± 0.7) compared to sutures (HWES: 3.3 ± 0.6, p = 0.003). Complication rates, including infection, discharge, and hypertrophic scar formation, were comparable between the two methods. Conclusion Staple closure in orthopedic surgeries offers several advantages over sutures, including reduced operative time, less pain during removal, and superior cosmetic results. These benefits occur without an increased risk of wound complications. This study suggests that staples may be a preferable option for skin closure in orthopedic procedures, though further research with extended follow-up is needed to fully assess long-term outcomes.

Time for change: compliance with RCS green theatre checklist-facilitators and barriers on the journey to net zero.

Climate change is an era-defining health concern, with healthcare related emissions paradoxically compounding negative impacts. The NHS produces 5% of the UK's carbon footprint, with operating theatres a recognised carbon hotspot. NHS England aims to become Net Zero by 2045. Consequently, UK Royal Colleges of Surgery have published guidance to foster an evidence-based sustainable transformation in surgical practice. A single-centre quality improvement project was undertaken, aiming to provide an overview of sustainable practice locally. The Intercollegiate "Green Theatre Checklist" was taken as an audit standard, focusing on "preparing for surgery" and "intraoperative equipment" subsections. Any general surgical procedure was eligible for inclusion. Usage of reusable textiles, non-sterile gloves, catheters, antibiotics, alcohol vs. water-based scrub techniques, skin sterilisation choices, and skin closure materials were recorded. Baseline data collection occurred over a 3 week period, followed by dissemination of results locally via clinical governance meetings and poster displays. A re-audit of practice was conducted using the same methodology and duration. Datasets 1 (n = 23) and 2 (n = 23) included open (n = 22), laparoscopic (n = 24), elective (n = 22) and non-elective (n = 24) cases. Good practice was demonstrated in reusable textiles (trolley covers 96%, 78%, drapes 100%, 92%) however procurement issues reduced otherwise good reusable gown use in Dataset 2 in (90%, 46%). No unnecessary catheter use was identified, and loose skin preparations were used unanimously. Uptake of alcohol-based scrubbing techniques was low (15%, 17%) and unnecessary non-sterile glove use was observed in >30% of procedures. All laparoscopic ports and scissors were single use. Carbon footprints were 128.27 kgCO2e and 117.71 kgCO2e in datasets 1 and 2 respectively. This project evidences good practice alongside future local focus areas for improved sustainability. Adoption of hybrid laparoscopic instruments, avoiding unnecessary equipment opening, and standardising reusable materials could reduce carbon and environmental impact considerably. Successful implementation requires considered procurement practices, improved awareness and education, clear leadership, and a sustained cultural shift within the healthcare community. Collaboration among professional institutions and access to supporting evidence is crucial in driving engagement and empowering clinicians to make locally relevant changes a reality.

Comparison of the effect of skin closure materials on skin closure during cesarean delivery.

ObjectiveTo compare the effect of skin closure materials on skin closure during cesarean delivery.MethodsWe searched EMBASE、PubMed、Scopus、Cochrane CENTRAL for randomized controlled trials (RCTs) on the use of closure materials for skin closing effect during cesarean delivery. The outcomes were time to skin closure of dermal and epidermal layer, skin separation rate and wound complications(wound infection, hematoma,seroma, reclosure, readmission) reported as an odds ratio (OR) and surface under the cumulative ranking curve analysis (SUCRA) score.ResultsTwenty -six RCTs met the inclusion criteria. In the network meta-analysis (NMA) for time to skin closure of dermal and epidermal layer, pooled network OR values indicated that staple (network SMD, -337.50; 95% CrI: -416.99 to -263.18) was superior to absorbable suture. In the Skin separation NMA, pooled network OR values indicated that the absorbable suture (network OR, 0.37; 95% CrI: 0.19 to 0.70) were superior to staple. In the wound complications NMA, pooled network OR values indicated that the no interventions were superior to staple.ConclusionIn conclusion, our network meta-analysis showed that the risk of skin separation with absorbable suture after cesarean delivery was reduced compared with staple, and does not increase the risk of wound complications, but the wound closure time would slightly prolonged.

Current practice of thyroid surgery in Germany: a nationwide survey.

Due to the lack of perioperative standards in thyroid surgery, this study aimed to evaluate the perioperative management and wound closure techniques used in a nationwide survey. A questionnaire evaluating preferred technique in thyroid resection, postoperative management, and the occurrence of complications was sent to all hospitals in Germany performing more than 50 thyroid operations p.a. (N.=362, response rate 78% [N.=283]). Subsequently, hospitals were subdivided into university and maximum care hospitals (Category A, N.=54) and tertiary hospitals and basic care hospitals (Category B, N.=229). According to our results, 10.6% of the hospitals were certified as a center for thyroid surgery, with a significantly higher percentage in Category A (20.4% vs. 8.3%; P<0.01). Concerning the surgical techniques, Kocher's incision was the favored cervical approach in 96% of the hospitals. A minimally invasive approach was performed in 30.1%, with a significantly more common description in Category A; 97.8% of all clinics stated that they perform a platysma muscle suture, primarily as a single stitch interrupted. Skin closure was predominantly performed via intracutaneous suture in 84.5% using absorbable suture material in 63.1%. There was no difference in the technology used in terms of hospital size. The mean in-hospital stay was significantly shorter in Category A hospitals (P=0.035). The suture technique used in thyroid surgery in Germany is a simple interrupted suture technique for platysma and a continuous suture with absorbable skin closure material. Maximum care hospitals are characterized by shorter in-hospital stays and improved quality assurance.

Comparative Evaluation of Three Skin Closure Materials- A Microbiological Pilot Study

Introduction: The goal of a skin closure technique is to precisely approximate the wound edges without tension for sufficient time, to allow healing to take place. The presence of a suture in surgical wounds has been found to increase the tissue’s susceptibility to infection. Increased microbial colonisation in a particular area results in higher risk of infection. There are limited studies investigating the presence and the type of microbial colonisation with respect to different skin closure techniques, especially metal staples. Aim: To compare and analyse microbial colonisation and wound complications in association with the use of surgical staples, nylon and polypropylene suture material; and to compare and analyse the incidence of wound complications in association with these three materials. Materials and Methods: A cross-sectional study was conducted on 60 patients, of which 20 underwent closure by prolene, 20 by nylon and 20 by metal staples. The prolene sutures, nylon sutures and staples were removed on 8th to 14th day postoperatively. The removed suture fragments and the staples were inoculated aerobically in suitable culture media according to the standard methodology to look for microbial growth. The results were derived using repeated measures ANOVA and Chi-square test. Results: A total of 70% of the patients from prolene group were found to have bacterial growth on microbial colonisation, whereas 30% did not show any growth. In the nylon group, 50% of the patients demonstrated bacterial growth whereas the rest of the 50% showed no growth. In the staples group 95% of the patients did not show any bacterial growth on culture media and only 5% showed positive bacterial growth. All of these differences were highly statistically significant (p&lt;0.001). The most common colonising bacteria was Staphylococcus aureus followed by Klebsiella spp followed by Pseudomonas aeruginosa. Conclusion: The findings of this study suggested that prolene was most prone to bacterial colonisation followed by nylon and staples. The most common micro-organisms found were Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella spp.

WOUND COMPLICATIONS;

Cesarean section is the most commonly performed abdominal operations on women worldwide. Its rate has increased markedly in recent years in most developed countries. Due to insufficient available data regarding the best suture materials for cesarean skin closure, we conducted a study “to compare the efficacy of 2 suture materials non absorbable prolene 2-0 and absorbable suture vicryl (2-0), brand Ethicon as subcuticular skin stitches in women undergoing elective cesarean section. Study Design: Prospective, observational study. Setting: Department of Obstetrics and Gynecology, Bahawal Victoria Hospital Bahawalpur. Period: 6 months. Materials and Methods: A total of 200 women fulfilling inclusion and exclusion criteria as above were enrolled for the present study. They were divided into 2 groups of 100 each by systematic sampling technique. Results: There is statistically significant difference related to post-operative wound complication parameters between non absorbable vs absorbable suture material on day 8, 15, 30 and 45. More number of patients having absorbable suture had pain, tenderness swelling and indurations. Maximum number of participants, that is, 86 (86%) and 93 (93%) from Group 1 showed excellent wound healing at day 30 and day 45 of caesarean section as compared to 63 (63%) and 66 (68%) from Group 2. Conclusion: The non-absorbable suture (prolene) was better in terms of wound healing and cosmesis as compared to absorbable suture used in our study (vicryl).

229: Use of tissue grafts for in-utero spina bifida closure of large skin defects

In-utero spina bifida closure of large defects is often challenging, requiring tissue graft (acellular dermal matrix or bovine collagen materials) for watertight skin closure. Using the fMMC Consortium registry sponsored by NAFTNet, we compared risk factors for tissue graft utilization and outcomes of primary skin closure vs. tissue graft closure. The fMMC Consortium registry is an international prospectively collected dataset including 296 patients from 15 centers during the period 2011-2018. Overall inclusion for in-utero spina bifida closure adhered to MOMS study criteria. The decision for the use of a tissue graft or the type of tissue graft was at the discretion of the pediatric neurosurgeon at the respective site. The perioperative management protocol was also institution dependent. Data collected included maternal demographics, fetal preoperative evaluation, operative outcomes, use of patch, and neonatal and childhood outcomes to age 3 years. The comparative statistics were performed with p-value of <0.05 considered significant. Overall 23% (67/296) of patients required fetal spina bifida closure using a tissue graft for skin closure. The comparison between the two groups is illustrated in Table 1. The risk factors for the use of tissue graft included higher lesion level and no covering sac. There were no differences in maternal age, gravidity, parity, ventricular size, or gestational age at procedure. The rate of preterm premature rupture of membranes and the gestational age at delivery were similar in the two groups. The development of syringomyelia was 5-fold higher with use of tissue graft. Shunt placement was 1.3-fold higher with tissue graft but did not reach statistical difference. There was a trend towards high risk of tethered cord in the tissue graft group. The higher level lesions or myeloschisis are more likely to need tissue grafts for the closure of skin during in utero spina bifida closure. These children are at higher risk of developing syringomyelia at the repair site. Further exploration of the mechanisms and optimal methods of wound closure are urgently needed.

Surgical glue- a promising technology for wound healing

Wound closure is one of the important steps of surgical dressing and suturing is the most commonly used method of wound closure. The process of suturing takes very long time for surgery and increases the patient’s risk of anesthesia awareness. Skin glues are a safe and effective method to close selected wounds. They are also cost-effective and help prevent infection. Ideally, wounds should be less than 4 cm, not contaminated or infected and have skin edges that are not under tension. Wounds should be closed within 12 hours. Novel methods of wound closure have been introduced to address these issues, most notably cyanoacrylate tissue glues. The evidence would suggest that the use of cyanoacrylate tissue glue is associated with a reduction in closure time and costs. On a daily basis, dermasurgeons are facing different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness is preferred.

Comparison of suture materials for subcuticular skin closure at cesarean delivery

Subcuticular skin closure with suture after cesarean has been shown to result in lower rates of wound complications than with staple closure. However, the optimal choice of suture material for subcuticular skin closure is unclear. Vicryl (a braided multifilament synthetic suture; Ethicon, Somerville, NJ) and Monocryl (a monofilament synthetic suture; Ethicon) are the commonly used suture materials for subcuticular closure of transverse skin incisions after cesarean in the United States. Whereas invitro and animal studies suggest multifilament suture materials may be associated with a higher risk of wound infection than monofilament sutures, clinical data on their relative effectiveness are limited. We sought to test the hypothesis that Vicryl is associated with a higher rate of wound complications than Monocryl. This is a secondary analysis of data from a randomized trial in which pregnant women undergoing scheduled or unscheduled cesareans were randomly assigned to preoperative skin preparation with either chlorhexidine-alcohol or iodine-alcohol. Women with low transverse skin incisions who were closed with either 4-0 Monocryl or 4-0 Vicryl were included in this analysis. Choice of suture material was at the discretion of the operating physician. The primary outcome was superficial or deep surgical site infection within 30 days after cesarean. Secondary outcomes were other wound complications. Outcomes were compared between the 2 groups using univariable and multivariable statistics. Of 1082 patients who had follow-up after discharge in the primary trial, 871 had subcuticular suture: 180 with 4-0 Vicryl and 691 with 4-0 Monocryl. Skin closure with Vicryl or Monocryl did not significantly differ between women allocated to chlorhexidine-alcohol or iodine-alcohol (51.1% vs 49.4%, P= .67). There was no significant difference in the risk of surgical site infection in women closed with Vicryl compared with Monocryl (11 [6.1%] vs 35 [5.1%]; P= .58; adjusted odds ratio, 1.23; 95% confidence interval, 0.60-2.49). Rates of other wound complications were also not significantly different. Risks of surgical site infection were similar with Vicryl and Monocryl closure in all subgroups assessed. The relative risks were not materially affected by whether diabetes or obesity was present, cesarean was scheduled or unscheduled, primary or repeat cesarean, or the subcutaneous layer was closed. Post hoc power analysis indicated that we had 80% power to detect >2-fold difference in surgical site infections. Subcuticular skin closure with 4-0 Vicryl is associated with comparable rates of surgical site infection and other wound complications as 4-0 Monocryl. While this is an observational study with the potential for selection bias and residual confounding, our results suggest physician preference is acceptable for choice of subcuticular suture material at cesarean.

Three techniques for skin closure in caesarean section (stapler, absorbable subcuticular, non-absorbable subcuticular suture)

Background & Objectives: Caesarean section is the most commonly performed surgery in obstetrics. Skin closure after surgery can have an important bearing on the post operative recovery. This study was done to compare the effect of skin closure technique and material on post Operative Swelling & induration, Wound discharge ,Cosmetic outcome (Vascularity, Height of wound), Satisfaction about scar & mean time for skin closure. Methods: This study was conducted on 156 woman admitted to the labour room in SVBP Hospital associated to LLRM Medical college Meerut, from 1st June 2014 to 1st July 2015 who underwent caesarean section. Patients undergoing primary caesarean section with Pfannenstiel or Transverse incision were included. Patients were divided into three groups depending on the type of skin closure method (Group A-Surgical Staples, Group B-Non absorbable subcuticular stitch, Group C-Absorbable Subcuticular Stitch). Results: In our study, swelling, induration & wound discharge were more in patients receiving staplers. Patients were most satisfied with the absorbable suture technique. Interpretation & Conclusions: In terms of wound complications after 6 weeks of skin closure in caesarean section, satples, non absorbale & absorbable sutures have no major differences. Absorbale sutures for skin closure in caesarean section provide best results in terms of patient satisfaction about scar. Key words: Skin closure, Caesarean section, Staplers, Sutures

Effects of different suture patterns and materials on healing of incised skin wounds in cattle

Studies on skin closure techniques are scarce in veterinary practice. The aesthetic result of a skin suture is hardly considered in ruminants. This study was designed to compare the morphological characteristics and outcome of incised skin wounds closed with three suture patterns using two suture materials. Simple interrupted (SI), cross mattress (CM) and horizontal mattress (HM) suture patterns were used with nylon and silk to close incised skin wounds. A total of 54 surgical wounds were made in nine cattle. Follow-up information was obtained up to day 30 postoperatively. Area of wound, elevation of suture line from the skin surface, width of suture area and contraction length per week was recorded. Silk caused more tissue reaction and suture marks than nylon. Simple interrupted suture produced good apposition but showed suture marks. Horizontal mattress caused marked tissue swelling, inflammation, sloughing of cutting edges due to prominent eversion and strangulation of cutting edges and produced prominent scar. Cross mattress produced good apposition with sufficient eversion of cutting edges and good cosmetic appearance with fewer suture marks. It is suggested that cross mattress pattern with nylon could be a better choice for closing skin wounds in ruminants. This study could help veterinary surgeons to consider appropriate suture technique and materials for skin closure. DOI: http://dx.doi.org/10.3329/bvet.v31i1.22840 Bangl. vet. 2014. Vol. 31, No. 1, 27-37

Evaluation of the Outcome of IRPG 910 and Polypropylene in Terms of Cosmesis and Cost for Skin Closure in Cleft lip Surgery

This prospective, comparative and interventional study was conducted in Bangabandu Sheikh Mujib medical university in Dhaka and Center Point Hospital pvt .ltd in chittagong to evaluate advantage of using readily absorbable synthetic suture material IRPG 910 over non absorbable polypropylene in repair of cleft lip between time period of January 2003 to May 2004 in fulfillment of final part MS degree in pediatric surgery. A total of 26 patients with cleft lip (with or without cleft palate) who underwent operative procedure were included in this study. All the patients between the age of 3 months to 10 years having unilateral cleft lip with or without cleft palate were included while those with grossly deformed face or those associated with major anomaly were excluded. Patients were divided into two groups, one group with 12(46%) as cases were IRPG 910 was used as a skin closure material and one group with 14(56%) as control group where polypropylene was used. In all the cases Milard’s procedure was used except for one with central defect where linear closure was done, at the end of the study it is justified that IRPG 910 is as good as polypropylene as a suture material of choice in repair ofcleft lip considering every pros and cons of both suturematerials namely cost effectiveness, patientcompliance, post operative complication and out come. The most beneficial thing about using IRPG 910 over polypropylene was that it can avoid second anesthesia for stitch removal.DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19451

Risk factors for wound infection in surgery for spinal metastasis

Wound infection rates are generally higher in patients undergoing surgery for spinal metastasis. Risk factors of wound infection in these patients are poorly understood. To identify demographic and clinical variables that may be associated with patients experiencing a higher wound infection rate. Retrospective study with prospectively collected data of spinal metastasis patients operated consecutively at a University Teaching Hospital, adult spine division which is a tertiary referral centre for complex spinal surgery. Ninety-eight patients were all surgically treated, consecutively from January 2009 to September 2011. Three patients had to be excluded due to inadequate data. Physiological measures, with presence or absence of microbiologically proven infection. Various demographic and clinical data were recorded, including age, serum albumin level, blood total lymphocyte count, corticosteroid intake, Malnutrition Universal Screening Tool (MUST) score, neurological disability, skin closure material used, levels of surgery and administration of peri-operative corticosteroids. No funding was received from any sources for this study and as far as we are aware, there are no potential conflict of interest-associated biases in this study. Higher probabilities of infection were associated with low albumin level, seven or more levels of surgery, use of delayed/non-absorbable skin closure material and presence of neurological disability. Of these factors, levels of surgery were found to be statistically significant at the 5% significance level. Risk of infection is high (17.9%) in patients undergoing surgery for spinal metastasis. Seven or more vertebral levels of surgery increase the risk of infection significantly (p<0.05). Low albumin level and presence of neurological disability appear to show a trend towards increased risk of infection. Use of absorbable skin closure material, age, low lymphocyte count, peri-operative administration of corticosteroids and MUST score do not appear to influence the risk of infection.

Surgical site infection after cesarean section: Implementing 3 changes to improve the quality of patient care

Surgical site infection (SSI) is an important complication of cesarean section (CS) delivery and a key quality indicator of patient care. A baseline assessment was undertaken to determine SSI rates, and subsequently a quality improvement program was introduced, followed by repeat surveillance. Data were collected during in-hospital stays and for up to 30 days after CS during both periods. Interventions in the quality improvement program included the use of nonabsorbable sutures for skin closure, use of clippers instead of razors, and use of 2% ChloraPrep for skin disinfection before incision. A total of 710 patients were surveyed before the interventions, and 824 patients were surveyed after the interventions. Of these, 114 (16%) had an SSI before the interventions, and 40 (4.9%) had an SSI after the interventions (P < .001; odds ratio, 0.27), with 90% and 83%, respectively, detected after hospital discharge. In multivariate analysis, obesity (P = .002) and the use of absorbable suture materials for skin closure (P = .008) were significantly associated with a higher SSI rate before the interventions; however, only obesity was associated with a higher SSI rate after the quality program. Surveillance of SSI rates after CS followed by 3 interventions contributed to a significant reduction in SSI rate and improved patient care.

Cutaneous wound closure materials: An overview and update

Introduction:On a daily basis, dermasurgeons are faced with different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky.Objectives:We aimed to review the available skin closure materials over the past 20 years and the scientific claims behind their effectiveness in repairing various kinds of wounds.Materials and Methods:The two authors independently searched and scrutinised the literature. The search was performed electronically using Pub Med, the Cochrane Database, Google Scholar and Ovid as search engines to find articles concerning skin closure materials written since 1990.Conclusion:Many factors are involved in the choice of skin closure material, including the type and place of the wound, available materials, physician expertise and preferences, and patient age and health. Evidence-based main uses of different skin closure materials are provided to help surgeons choose the appropriate material for different wounds.

Techniques and materials for skin closure in caesarean section.

Caesarean section is a common operation with no agreed upon standard regarding certain operative techniques or materials to use. With regard to skin closure, the skin incision can be re-approximated by a subcuticular suture immediately below the skin layer, by an interrupted suture, or by 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. To compare the effects of skin closure techniques and materials on maternal and operative outcomes after caesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 January 2012). All randomized trials comparing different skin closure materials in caesareans were selected. Two review authors independently abstracted the data. We identified 19 trials and included 11, but only eight trials contributed data. Three trials were not randomized controlled trials; two were ongoing; one study was terminated and the results were not available for review; one is awaiting classification; and one did not compare skin closure materials, but rather suture to suture and drain placement. The two methods of skin closure for caesarean that have been most often compared are non-absorbable staples and absorbable subcutaneous sutures. Compared with absorbable subcutaneous sutures, non-absorbable staples are associated with similar incidences of wound infection. Other important secondary outcomes, such as wound complications, were also similar between the groups in women with Pfannenstiel incisions. However, it is important to note, that for both of these outcomes (wound infection and wound complication), staples may have a differential effect depending on the type of skin incision, i.e., Pfannenstiel or vertical. Compared with absorbable subcutaneous sutures, non-absorbable staples are associated with an increased risk of skin separation, and therefore, reclosure. However, skin separation was variably defined across trials, and most staples were removed before four days postpartum. There is currently no conclusive evidence about how the skin should be closed after caesarean section. Staples are associated with similar outcomes in terms of wound infection, pain and cosmesis compared with sutures, and these two are the most commonly studied methods for skin closure after caesarean section. If staples are removed on day three, there is an increased incidence of skin separation and the need for reclosure compared with absorbable sutures.

A randomised controlled trial on suture materials for skin closure at caesarean section: Do wound infection rates differ?

Objective.The aim of this study was to determine wound complication rates following the use of suture materials and staples for skin closure at caesarean section (CS). A randomised, controlled, prospective study was undertaken. Results. A total of 1 100 women was assigned randomly into 3 groups: polyglycolic acid (PGA) suture group (N=361), skin staple (SS) group (N=373) and nylon suture group (N=366). The overall wound infection rate was 7%. There was no difference in respect of number of patients, age, parity and gestation between the study groups. Those who had nylon sutures as opposed to PGA sutures were 9.5 times more likely to experience wound infection (p=0.055). Women who had SS were at 6.93 times higher risk of wound infection than those who had PGA sutures (p=0.014). Other factors influencing wound infection rates included: rupture of membranes >12 hours were 13.7 times (95% confidence interval (CI) 3.9 - 47.9, p<0.0001) more likely to have wound infection than those with rupture of membranes <12 hours. For every 1-minute increase of surgery duration, the risk of infection increased 1.094 times (95% CI 1.046 - 1.145; p<0.0001). HIV-infected women were 53.4% less likely to develop wound infection than their uninfected counterparts (odds ratio 0.466, 95% CI 0.238 - 0.913; p=0.026). As the time period of observation increased from baseline to day 3 and from day 3 to day 10, wound infection risk increased by 35 times (95% CI 8.155 - 150.868; p<0.001). Conclusion.The use of SS for CS wound closure is associated with a significantly greater risk of wound infections. SS for wound closure at CS is not recommended for use in South African district hospitals.

A pilot study: a randomised study comparing the use of two different suture materials for subcuticular skin closure at caesarean section (CS)

Background/Introduction/AimsIn current obstetric practice there is limited evidence to underpin the wide variation of suture material used for skin closure at caesarean section. A pilot study examined the rates of...

A review of sutures and other skin closure materials

A review of sutures and other skin closure materials

Use of cyanoacrylate in skin closure for ovariohysterectomy in a population control programme

N-butyl-cyanoacrylate tissue adhesive was evaluated as a skin closure material in a population control programme. Fifty-two female cats underwent ovariohysterectomy: skin closure of 25 of those cats was undertaken with nylon (3-0) and in 27 with the adhesive. Twenty-three cats spent the postoperative period confined in cages and 29 were free within a 50-square-metre fenced area. The parameters used for evaluation were: dehiscence or secretion and presence and extension of erythema at the surgical site. It was observed that the time required for closure of the surgical site with the adhesive was shorter than with nylon, saving approximately 1 min per animal. The adhesive or conventional suture allowed similar healing, and independent of material used for skin closure or the postoperative exercise, there was no statistical difference in wound cicatrization. As the adhesive eliminates the need for suture removal and decreases surgery time, without additional risk to the cat, it may be indicated for surgical population control programmes.