Subcuticular Suture For Skin Closure Research Articles

What's New in Adult Reconstructive Knee Surgery.

What's New in Adult Reconstructive Knee Surgery.

Octyl cyanoacrylate skin adhesive with or without subcuticular suture for skin closure after implantable venous port placement for oncology patients: a propensity-score matching analysis

To compare peri-operative outcomes of skin closure with octyl cyanoacrylate (OCA) skin adhesive (Dermabond) with or without subcuticular sutures after deep dermal suturing for implantable venous port placement closure. Seven hundred and ninety-two single-lumen implantable venous port insertions for chemotherapy were reviewed from September 2019 to March 2021 in a retrospective single-centre study. Propensity-score matching by a 1:1 nearest neighbour algorithm was conducted to control for confounding baseline differences. Distances were determined by logistic regression. Propensity-score matching was performed based on the following variables: age at procedure, gender, race, operator's seniority, use of anchoring polypropylene suture (PROLENE), port model, and volume of intra-operative local analgesia. The primary outcome was wound dehiscence at the first follow-up (∼1 week). The 792 port insertions were conducted in 302 males (38.1%), median age 63 years (IQR: 54-69). Of the 656 wounds closed with subcuticular sutures and skin adhesive, 136 were matched in a 1:1 fashion against procedures closed without a subcuticular suture. No significant differences were demonstrated in pain scores, bleeding, swelling, bruising, fever, wound dehiscence, and discharge at postoperative day 1 (POD1) and at first follow-up between the groups (all p>0.05). Of note, no significant differences in wound dehiscence at first follow-up was found in both unmatched (p=0.133) and matched cohorts (McNemar-Bowker's χ2=1.167, p=0.761). These findings suggest that the omission of subcuticular sutures during implantable venous port closure may not compromise peri-operative outcomes when OCA skin adhesives were used.

Does method of closure effect cesarean wound healing? Stapler versus absorbable sub-cuticular closure done in a tertiary hospital, Nepal

Introduction: Postoperative wound complications for women undergoing cesarean delivery constitute a major cause of morbidity. Data on wound healing based on the type of cesarean wound closure is limited. In this study, we assess the outcome of stapler versus absorbable sub-cuticular suture for skin closure of the cesarean wound. Method: Prospective observational study. All cesarean section patients during the period of six months (Dec 2019 to May 2020) at Patan Hospital, Nepal, whose skin closure was done by sub-cuticular suture or stapler technique were recruited in the study. Ethical approval was obtained. These patients were followed up postoperatively on the 10th day for wound outcome (redness, edema, hematoma, seroma, discharge, gaping). Number and proportion were calculated, chi-square test, and Fisher’s exact test at 95% confidence interval were used to see the association and p<0.05 was considered significant. Result: Out of 379 patients, 26(6.9%) were lost to follow-up. Among 353 patients, an unhealthy wound was seen in 7(1.98%) during follow-up. Of these unhealthy wounds, closure with stapler technique was 5(71.4%) and by sub-cuticular technique, 2(28.6%), statistically significant with a p-value of 0.014. Conclusion: Cesarean wound closure by sub-cuticular technique had a better wound outcome compared to closure by staplers.

2-Octyl Cyanoacrylate Topical Adhesive as an Alternative to Subcuticular Suture for Skin Closure After Total Knee Arthroplasty: A Randomized Controlled Trial in the Same Patient

BackgroundThe 2-octyl cyanoacrylate topical adhesive with flexible self-adhesive polyester mesh (Dermabond Prineo) is becoming widely used in many surgical fields. However, no prior studies have tested the efficacy and safety of this topical adhesive compared with subcuticular suture in the same patient. The purpose of this study was to compare the efficacy and safety between Dermabond Prineo and subcuticular suture for skin closure in patients undergoing same-day bilateral total knee arthroplasties (TKAs). Materials and MethodsA prospective, double-blind randomized controlled trial was performed in 51 patients scheduled to undergo same-day bilateral TKAs. One knee was randomly assigned to the Dermabond Prineo and the other knee was allocated to the subcuticular suture. As primary outcomes, Vancouver scar scale was evaluated at 6 months and Patient and Observer Scar Assessment Scale was evaluated at 2 weeks, 6 weeks, 3 months, and 6 months. Secondary outcomes included cosmesis efficacy (Hollander wound evaluation scale [HWES] and cosmesis visual analog scale [VAS]), time and pain efficiency (skin suture time, stitch out time, and stitch out pain VAS), and safety (wound complications during the 6-month follow-up period). The primary and secondary outcome measures were compared between groups. ResultsThere were no significant differences in Vancouver scar scale and Patient and Observer Scar Assessment Scale at 6 months. Although there were no significant differences in HWES at 2 weeks, the Dermabond Prineo group showed better step-off border item of HWES. There was also no difference in cosmesis VAS at 6 months. The Dermabond Prineo group showed superior results in terms of time (suture time: Dermabond Prineo = 191 second (sec) ± 60.1 sec, subcuticular suture = 356.8 sec ± 92.3 sec; stitch out time: Dermabond Prineo = 4 sec ± 1.3 sec, subcuticular suture = 26.6 sec ± 4.2 sec, all P < .001) without significant differences in pain scale (P = .823) or wound complications (all P > .05). ConclusionComparing cosmetic efficacy, time efficiency, and safety, Dermabond Prineo provided quicker wound closure, shorter stitch out time, and better wound margin coaptation in the early postoperative period but similar cosmetic efficacy compared with subcuticular suture. Based on our study, Dermabond Prineo is a useful alternative to subcuticular suture in patients undergoing TKA. Level of EvidenceTherapeutic level 1.

Subcuticular sutures versus staples for skin closure after primary hip arthroplasty

High-quality and cost-effective health care are highly recommended especially in joint replacement surgeries, particularly in total hip arthroplasty. Therefore, it is indispensable for orthopaedic surgeons to spot the potential areas of quality improvement. Evaluating the efficacy of the different ways of skin closure is an unacknowledged topic. We performed this study following both the Preferred Reporting Items for Systematic Reviews and Meta- analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Articles were from any country, written in any language. We included all randomised control trials and retrospective cohort studies undergoing primary total hip arthroplasty who either received staples or subcuticular sutures for skin closure. The primary outcome was the incidence of wound infection. Secondary outcomes included length of stay (LOS), time to skin closure, total cost, and patient's satisfaction. We included five studies in our cumulative meta- analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used Random-effect models. Primary skin closure with subcuticular sutures had insignificant marginal advantages for wound infections, LOS, and wound oozing. On the contrary, staples were more cost- effective and had less time for closure with higher patient's satisfaction. Except for closure time and patient satisfaction , no significant difference between the two groups. The use of staples after THA may have several slight clinical advantages over the subcuticular sutures. However, owing to the complexities associated with wound closure, future clinical and laboratory studies assessing their complication outlines must be examined before an optimum technique can be determined.

Cesarean wound closure in body mass index 40 or greater comparing suture to staples: a randomized clinical trial

Cesarean delivery is the most common major surgical procedure performed in the United States. Women with class III obesity have an increased risk of cesarean delivery and have wound complication rates higher than healthy body mass index counterparts. Available evidence regarding optimal wound closure is lacking specific to the population of women with class III obesity despite a known increased rate of wound complications. This study aimed to compare rates of postoperative wound complications among women with class III obesity (body mass index of ≥40 kg/m2) undergoing cesarean delivery with skin closure by either subcuticular suture or surgical staples. Patients were randomly assigned to skin closure by nonabsorbable stainless steel surgical staples or subcuticular suture of the surgeon's choice at the time of cesarean delivery at 2 university hospitals. Randomization was stratified for scheduled vs unscheduled cesarean delivery and for the 2 study sites. The primary outcome was the rate of any documented wound complication during the first 6 weeks after delivery. Any predictors of the composite outcome that in univariate analysis had a P<.20 were entered into a forward logistic regression. Sample size was calculated based on published literature and estimating the rate of wound complications within 6 weeks of follow-up at 20% with staples and 10% with sutures. For a power of 0.80 with a 2-tailed of 0.05, a total of 199 participants per group were required. From September 2015 to May 2019, 232 women were randomized to staples (n=117) or sutures (n=115). Nearing the planned interim analysis, enrollment in the study was concluded administratively owing to low enrollment. With loss to follow-up and exclusions, a total of 90 women were analyzed in each group. In the suture group, one-third was closed with braided suture and two-thirds were closed with monofilament suture. Median staple removal was 5 days postoperatively. Fewer composite wound complications were noted in the surgical staples group than the subcuticular suture group (20.0% vs 27.6%), although this difference was not statistically significant (P≥.5). The rate of surgical site infection was significantly lower in the staples group (10.5% vs 22.7%; P=.041). In the multiple logistic regression, the 3 significant independent predictors of the outcome were body mass index (odds ratio, 1.08; P=.004), scheduled vs unscheduled cesarean delivery (odds ratio, 0.40; P=.018), and study site (odds ratio, 0.36; P=.028). Surgical staples or subcuticular suture for skin closure at the time of cesarean delivery in women with a body mass index of ≥40 kg/m2 resulted in similar composite wound complication rates; however, lower cesarean wound infection rates were noted among wounds closed with staples.

Subcuticular sutures for skin closure in non-obstetric surgery.

Subcuticular sutures for skin closure in non-obstetric surgery.

Does Time of Wound Complication after Cesarean Delivery Differ by Type of Skin Closure?

A high proportion of postcesarean wound complications occur after patients have been discharged from the hospital, increasing personal and health care costs. We undertook this study to evaluate the association between skin closure methods (suture vs. staple) following a cesarean delivery and the frequency of wound complications occurring after hospital discharge. This is a secondary analysis of data from a randomized trial in which women undergoing cesarean delivery at ≥24 weeks' gestation were randomized to receive metallic staples or subcuticular suture for skin closure after surgery. Staples were removed at the time of hospital discharge on postoperative days 3 to 4 for Pfannenstiel incisions or days 7 to 10 for vertical. The primary outcome for this analysis was any wound complication occurring after hospital discharge. Wound complications were infections or any wound disruption without infection (including seromas and hematomas). Associations were examined using chi-square and Fisher's exact tests, as appropriate, and multivariable logistic regression. A total of 350 patients with follow-up through 4 to 6 weeks postpartum were included in the analysis: n = 171 received suture closure and n = 179 received staples. In the primary trial, wound complications occurred in 14.5% (n = 26) of individuals with staples and 5.9% (n = 10) with sutures (p = 0.008). Twenty-one (58.3%) of the 36 wound complications occurred after hospital discharge. The incidence of wound complications occurring after hospital discharge was 6.7% (n = 12) of patients receiving staples and 5.3% (n = 9) of those receiving sutures; p = 0.57; relative risk [95% confidence interval]: 1.27 [0.55-2.95]). After multivariable adjustment, type of skin closure method was not associated with wound complication after discharge from the hospital (odds ratio: 1.29; 0.52-3.17). Although suture closure compared with staples was associated with fewer wound complications after cesarean delivery, we found no significant differences between closure types in the frequency of wound complications occurring after hospital discharge.

Noninvasive tissue adhesive for cardiac implantable electronic device pocket closure: the TAPE pilot study

Device infection is a serious complication of cardiac implantable electronic devices (CIED). Ensuring complete pocket closure can be time consuming, but remains vital to prevent infection. The Zip® Surgical Skin Closure (ZIP) is a noninvasive adhesive device applied to the skin as an alternative to subcuticular sutures for skin closure. We hypothesized that using this device would decrease pocket closure times without increasing the risk of pocket infections. This is a single center, retrospective cohort study to compare pocket closure times and infection rates between ZIP and standard suture for CIED pocket closure. Two separate groups of consecutive new intravenous implants, upgrades, and pulse generator replacements from October 2015 to April 2017 were included. A total of 175 patients were included, using either ZIP (n = 80) or suture (n = 95). Total procedure time (local anesthetic to dressing application) and pocket closure time (fascial suture to dressing application) were compared. Pocket infections were defined as infections leading to CIED extraction or wound dehiscence requiring repeat procedure. Statistical analysis was performed using chi square test and Student's t test. Pocket closure time and procedure time were significantly shorter for the ZIP group (14.9 ± 6.8 vs 20.1 ± 11.09min, p = 0.0003) and (65.02 ± 30.4 vs 83.83 ± 40.3min, p = 0.0008), respectively. No pocket infections occurred in the Zip group, while the suture group had 2:1 wound dehiscence and 1 pocket infection. The ZIP device resulted in significantly shorter pocket closure and procedure times without increasing device pocket infections.

A Randomized Controlled Trial of Running Versus Interrupted Subcuticular Sutures for Skin Closure in Open Gastric Surgery

Objective: The aim of this study was to compare the scar quality associated with different types of subcuticular suture techniques: running or interrupted. Summary of Background Data: Subcuticular suture is a preferred skin closure method even in gastrointestinal surgery. Two methods for subcuticular suture are used: running or interrupted sutures. Methods: Inclusion criteria were as follows: age ≥ 20 years; American Society of Anesthesiologists performance status 1 to 3; histologically proven adenocarcinoma of the stomach; no evidence of distant metastases or disease considered unresectable; no prior upper abdominal surgery; no uncontrolled infections, diabetes, or cardiac disease; and adequate renal function. Patients were randomly assigned to running subcuticular suture or interrupted subcuticular suture. Scar areas were calculated using a digital photograph calculator at about 7 months after surgery. The observer scar assessment scale (OSAS) was used for scar assessment. Results: Between April 10, 2009, and February 28, 2012, 220 patients were enrolled into this study and 201 patients were evaluated. There was no difference in scar area between the interrupted group and the running group [0.97 cm2 (95% CI: 0.73–1.21) in the interrupted group and 1.17 cm2 (95% CI: 0.91–1.42, P = 0.27) in the running group]. Three observers performed the OSAS, for which no significant difference was detected across the closure groups. Conclusions: There were no significant differences in cosmetic outcomes between running and interrupted subcuticular sutures. The final decision about the choice of method should be made balancing surgeon needs (time-saving with running) and surgeon techniques (running might be difficult).

Comparison of staples vs subcuticular suture in class III obese women undergoing cesarean: a randomized controlled trial

Obesity is a risk factor for infectious morbidity and wound complications after cesarean delivery. There are currently insufficient data to determine optimal skin closure technique for cesarean delivery, specifically for those women with class III obesity, defined as a body mass index ≥40 kg/m2. We sought to compare stainless steel staples vs subcuticular suture for skin closure for cesarean delivery in class III obese women with body mass index ≥40 kg/m2. We conducted a randomized controlled trial at 2 teaching hospitals from 2015 through 2016 in which women with body mass index ≥40 kg/m2 undergoing cesarean delivery were randomly assigned to stainless steel staples or subcuticular suture skin closure. The primary outcome was composite wound complication defined as superficial or deep separation and infection occurring up to 6 weeks following delivery. Secondary outcomes included operative time, and patient pain and satisfaction scores. A total of 242 women were enrolled. In all, 119 in the staples group and 119 in the subcuticular suture group were analyzed. Maternal demographics and characteristics were similar in both groups. The composite wound complication frequency was 19.3% in the staples group and 17.6% in the subcuticular suture group (P= .74) with an overall wound complication incidence of 18.5% in the entire study cohort. There were also no differences in the frequencies of infection, or in superficial or deep wound separation between the 2 study groups. In a univariate analysis of predictors of wound complications, only current tobacco use was a significant predictor of wound complications (relative risk, 4.97; 95% confidence interval, 1.37-18.03; P= .02). Fewer women with staple closure would choose the same method with a future delivery (P= .01), however, self-reported pain and concern about wound healing were equal between the 2 groups. In class III obese women undergoing cesarean delivery, there was no difference in composite wound outcome up to 6 weeks postpartum between those who had staples and those who had subcuticular suture skin closure.

Randomized Controlled Trial of Octyl Cyanoacrylate Skin Adhesive versus Subcuticular Suture for Skin Closure after Implantable Venous Port Placement

PurposeTo compare early outcomes of skin closure with octyl cyanoacrylate skin adhesive versus subcuticular suture closure. Materials and MethodsOver a 7-month period, 109 subjects (28 men and 81 women; mean age, 58.6 y) scheduled to undergo single-lumen implantable venous port insertion for chemotherapy were randomly assigned to skin closure with either octyl cyanoacrylate skin adhesive or absorbable subcuticular suture after suturing the deep dermal layer. Subjects were followed for episodes of infection or dehiscence within 3 months of port implantation. At 3 months, photographs of the healed incision were obtained and reviewed by a plastic surgeon in a blinded fashion who rated cosmetic scar appearance based on a validated 10-point cosmesis score. ResultsOf subjects, 54 were randomly assigned to skin adhesive, and 55 were randomly assigned to subcuticular suture. No subjects had incision dehiscence. Infection rates at 3 months were similar between groups (2.1% vs 4.0%; P = 1.0). The mean cosmesis scores were 4.40 for skin adhesive and 4.46 for subcuticular suture (P = .898). The superficial skin closure time was 8.6 minutes for suture versus 1.4 minutes for skin adhesive (P < .001). ConclusionsScar cosmesis and patient outcomes did not significantly vary between skin adhesive versus subcuticular suture, although skin closure time was significantly less with skin adhesive.

Subcuticular sutures for skin closure in non-obstetric surgery

Subcuticular sutures for skin closure in non-obstetric surgery

8:54 AMAbstract No. 442 - Randomized controlled trial of skin adhesive versus subcuticular suture for skin closure after implantable venous port placement

8:54 AMAbstract No. 442 - Randomized controlled trial of skin adhesive versus subcuticular suture for skin closure after implantable venous port placement

A randomized controlled trial comparing cosmetic outcome after skin closure with ‘staples’ or ‘subcuticular sutures’ in emergency Cesarean section

To compare staples with subcuticular sutures for skin closure in emergency Cesarean sections (CS). One hundred and thirty women (undergoing emergency CS without previous abdominal delivery) were randomly assigned to either staples or subcuticular skin closure (monocryl 3-0). Primary outcome of the study was cosmetic outcome [as assessed by patient and independent observer: Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS), respectively], 6weeks post-operative. Secondary outcomes were wound complications, operating time, post-operative pain (visual analogue scale day 3 post-operative and patient assessment of pain in scar 6weeks post-operative), and duration of hospital stay. 112 women were available for evaluation of scar 6weeks post-operative. Cosmetic result of staples was significantly better than subcuticular sutures (PSAS and OSAS: p value 0.022 and 0.000, respectively), with significantly lesser duration of surgery (24 vs. 32min: p value 0.000) and comparable post-operative pain (pain on day 3 and 6weeks post-operatively: p value 0.474 and 0.179, respectively) and wound complications (p value 0.737). However, duration of stay in hospital was increased (6 vs. 3days: p value 0.001). Staples are the method of choice for skin closure in emergency CS as they are significantly better than subcuticular sutures with respect to cosmesis and duration of surgery. Post-operative pain and wound complications are comparable in two groups. However, staples are associated with significantly increased duration of hospital stay. Trial registered in clinical trial registry CTRI: REF/2013/05/005087.

Subcuticular sutures versus staples for skin closure after open gastrointestinal surgery: a phase 3, multicentre, open-label, randomised controlled trial

Staples have been widely used for skin closure after open gastrointestinal surgery. The potential advantages of subcuticular sutures compared with staples have not been assessed. We assessed the differences in the frequency of wound complications, including superficial incisional surgical site infection and hypertrophic scar formation, depending on whether subcuticular sutures or staples are used. We did a multicentre, open-label, randomised controlled trial at 24 institutions between June 1, 2009, and Feb 28, 2012. Eligible patients aged 20 years or older, with adequate organ function and undergoing elective open upper or lower gastrointestinal surgery, were randomly assigned preoperatively to either staples or subcuticular sutures for skin closure. Randomisation was done via a computer-generated permuted-block sequence, and was stratified by institution, sex, and type of surgery (ie, upper or lower gastrointestinal surgery). Our primary endpoint was the incidence of wound complications within 30 days of surgery. Analysis was done by intention to treat. This study is registered with UMINCTR, UMIN000002480. 1080 patients were enrolled and randomly assigned in a one to one ratio: 562 to subcuticular sutures and 518 to staples. 1072 were eligible for the primary endpoint and 1058 for the secondary endpoint. Of the 558 patients who received subcuticular sutures, 382 underwent upper gastrointestinal surgery and 176 underwent lower gastrointestinal surgery. Wound complications occurred in 47 of 558 patients (8·4%, 95% CI 6·3-11·0). Of the 514 who received staples, 413 underwent upper gastrointestinal surgery and 101 underwent lower gastrointestinal surgery. Wound complications occurred in 59 of 514 (11·5%, 95% CI 8·9-14·6). Overall, the rate of wound complications did not differ significantly between the subcuticular sutures and staples groups (odds ratio 0·709, 95% CI 0·474-1·062; p=0·12). The efficacy of subcuticular sutures was not validated as an improvement over a standard procedure for skin closure to reduce the incidence of wound complications after open gastrointestinal surgery. Johnson & Johnson.

Surgical Staples Compared With Subcuticular Suture for Skin Closure After Cesarean Delivery

To compare the risk of cesarean wound disruption or infection after closure with surgical staples compared with subcuticular suture. Women with viable pregnancies at 24 weeks of gestation or greater undergoing scheduled or unscheduled cesarean delivery were randomized to wound closure with surgical staples or absorbable suture. Staples were removed at postoperative days 3-4 for low transverse incisions and days 7-10 for vertical incisions. Standardized wound evaluations were performed at discharge (days 3-4) and 4-6 weeks postoperatively. The primary outcome was a composite of wound disruption or infection within 4-6 weeks. Secondary outcomes included operative time, highest pain score on analog scale, cosmesis score, and patient scar satisfaction score. Analyses were by intent to treat. Of 398 patients, 198 were randomized to staples and 200 to suture (but four received staples). Baseline characteristics including body mass index, prior cesarean delivery, labor, and type of skin incision were similar by group. The primary outcome incidence at hospital discharge was 7.1% for staples and 0.5% for suture (P<.001, relative risk 14.1, 95% confidence interval [CI] 1.9-106). Of 350 (87.9%) with follow-up at 4-6 weeks, the cumulative risk of the primary outcome at 4-6 weeks was 14.5% for staples and 5.9% for suture (P=.008, relative risk 2.5, 95% CI 1.2-5.0). Operative time was longer with suture closure (median time of 58 versus 48 minutes; P<.001). Pain scores at 72-96 hours and at 6 weeks, cosmesis score, and patient satisfaction score did not differ by group. Staples closure compared with suture is associated with significantly increased composite wound morbidity after cesarean delivery. : ClinicalTrials.gov, www.clinicaltrials.gov, NCT01008449. : I.

Staples Versus Subcuticular Sutures for Skin Closure at Cesarean Delivery

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Current Resources for Evidence‐Based Practice January/February 2012

The Institute of Medicine Report on Clinical Preventive Services for Women: From Evidence to Policy As a central component of the Affordable Care Act (ACA), new health insurance plans will be required to cover preventive health services without cost sharing to plan members beginning on or after August 1, 2012. In response to this directive within the ACA, the United States Department of Health and Human Services (HHS) charged the Institute of Medicine (IOM) with conducting a comprehensive review of women’s preventive health services and recommending those services deemed necessary for the health of women in the United States (Gee et al, 2011).

649: Randomized trial of surgical staples vs subcuticular suture for skin closure after cesarean delivery

649: Randomized trial of surgical staples vs subcuticular suture for skin closure after cesarean delivery