In women who undergo elective cesarean delivery, wound complications are lower in Pfannenstiel incisions closed with poliglecaprone 25 suture compared with in those who receive polyglactin 910 suture, a randomized comparative trial found.
“The incidence of wound complications after cesarean delivery comparing suture and staple skin closure has been extensively studied with suture being superior,” Arin Buresch, MD, from Kaiser Permanente San Diego, California, and colleagues report.
“[And now we’ve] found that for skin closure after delivery, poliglecaprone 25 suture was associated with a 40% reduction in the rate of wound complications when compared with polyglactin 910 suture,” they add.
The researchers present their findings in an article published online August 4 and in the September issue of Obstetrics & Gynecology.
The primary outcome was a composite outcome of a wound complication during the first 30 days postoperatively that included one or more of the following: a wound separation of 1 cm or more in length, hematoma, seroma, or surgical site infection.
In an intention-to-treat analysis, 8.8% of women who underwent subcuticular closure of their Pfannenstiel skin incision with the 3-0 poliglecaprone 25 (Monocryl) suture experienced the primary outcome compared with 14.4% of women in whom a 4-0 polyglactin 910 (Vicryl) suture was used (relative risk, 0.61; 95% confidence interval, 0.37 – 0.99; P = .04).
Surgeons would need to treat 18 women with the poliglecaprone 25 suture to prevent one composite wound complication after caesarean section.
The study was carried out in labor and delivery units at two medical centers in California. During slightly more than 1 year, 275 women were randomly assigned to undergo cesarean delivery in which the poliglecaprone 25 suture was used, and another 275 women were randomly assigned to the same procedure with skin closure using the polyglactin 910 suture.
The final analysis included 263 women in the poliglecaprone 25 suture group, 231 of whom underwent the procedure with the assigned suture, and 257 women in the polyglactin 910 group, 209 of whom received the assigned suture.
Groups were well balanced in terms of demographics, comorbidities, and perioperative characteristics, the researchers note. The investigators calculated outcomes by intention-to-treat analysis as well as by the actual suture received. In the intent-to-treat analysis, rates of specific wound complications were usually higher in the polyglactin 910 suture group as well.
Table. Wound Complication Rates: Intent-to-Treat Analysis
| Complication | Poliglecaprone 25 | Polyglactin 901 |
| Surgical site infection | 6.1% | 9.7% |
| Hematoma | 0.4% | 1.2% |
| Seroma | 0.8% | 0.4% |
| Separation | 2.7% | 5.1% |
When the researchers looked at the wound complication rate by actual suture received, the rate of wound complications was also lower in the poliglecaprone 25 suture group (8.3%) compared with the polyglactin 910 counterpart (13.8%), for a 40% reduction in the relative risk of developing a complication during the first 30 days postdelivery.
In this analysis, however, the difference between the two suture groups was no longer statistically significant (P = .05).
Lack of Braiding
Poliglecaprone 25 is a monofilament suture that is absorbed within 91 to 119 days postoperatively, the authors explain. The polyglactin 910 in turn is a braided suture which is absorbed much more quickly within 56 to 70 days after surgery. “Cesarean incision closure with poliglecaprone 25 suture is associated with a significantly decreased rate of wound complications when compared with polyglactin 910 suture,” they write. “We speculate that this significant difference was the result of the lack of braiding in the poliglecaprone 25 suture that allowed for increased resistance to infection.”
In an accompanying audio clip, Nancy Chescheir, MD, editor-in-chief of Obstetrics & Gynecology, observed that most wound complications show up early, not 56 to 119 days after the wound has been closed.
“When I was a medical student, surgeons made a big deal out of time to dissolution of absorbable sutures,” she said. “So the fact that the length of time it takes the suture to dissolve in the wound isn’t the issue here, there’s something else going on earlier in the process of wound healing that is making the difference here,” she noted. “Some of the simple things make the best science,” She added.
The authors have disclosed no relevant financial relationships.
Obstet Gynecol. 2017;130:521-526. Abstract
For more news, join us on Facebook and Twitter
Tidak ada komentar:
Posting Komentar