Comparison Of Subcuticular Suture Type In Post-Cesarean Wound Complications: A Randomized Controlled Trial

To compare poliglecaprone 25 (Monocryl) and polyglactin 910 (coated Vicryl) for cesarean incision closure to determine rates of wound complication. Patients undergoing non-emergent cesarean delivery ≥ 37 weeks of gestation were randomized to receive poliglecaprone 25 or polyglactin 910 for subcuticular skin closure of Pfannenstiel incisions. The primary outcome was wound complication within the first 30 days postpartum. Wound complication was defined as wound separation of ≥ 1 cm in length, hematoma or seroma (at least moderate serous fluid collection or subcutaneous blood collection), and surgical site infection as defined by the Centers for Disease Control and Prevention. Standard statistical methods were employed. In 14 months, 383 patients were randomized; poliglecaprone (n=192) and polyglactin (n=191). Poliglecaprone (n=186) and polyglactin (n=175) patients completed 30-day follow-up. There was no significant difference found in demographic information (age, BMI, ethnicity, gestational age, gravidity, parity) between study groups. The overall cohort composite wound complication rate was 10.0% (n=36). The composite wound complication rate for poliglecaprone vs. polyglactin was 6.5% vs. 13.7%, respectively (p=.02). The overall rate of surgical site infection was 6.7% (n=24) with 4.3% in the poliglecaprone group compared to 9.1% in the polyglactin group (p=.09). In this first randomized controlled trial in the literature specifically focused on the use of absorbable suture for abdominal wound closure at cesarean, we found that polyglactin suture significantly increases risk for wound complications when compared to poliglecaprone suture in a large, diverse, and high risk population. We believe the use of poliglecaprone resulted in fewer wound complications because it is a monofilament suture with a longer absorption time.