After C-section, stitches or staples?

Women who deliver by cesarean section seem to have similar cosmetic results whether the wound is closed with stitches or staples, a new study suggests.

There are a number of ways that surgeons can close a C-section wound - using staples or different types of stitches, including ones that need to be removed and those made of materials that are absorbed into the body. But little has been known about whether the cosmetic results vary with the different methods.

For the new study, Italian researchers randomly assigned 180 women undergoing a C-section to have one of four methods of wound closure: staples or one of three types of sutures, including absorbable stitches and stitches that had to be removed.

After two and six months, the study found, there were no overall differences among the groups’ cosmetic results - based on both an independent plastic surgeon’s ratings and the women’s own perceptions of their scar healing.

The findings suggest that, generally speaking, women who have a C- section can expect to get similar aesthetic results regardless of the type of wound closure, lead researcher Dr. Antonella Cromi, of the University of Insubria in Varese, Italy, told Reuters Health in an email.

That said, though, results do vary from patient to patient, and they also depend on factors other than the use of staples versus stitches.

“The final appearance and function of the healed skin is dependent on patient factors which are often outside the control of a surgeon,” Cromi said.

Women with darker skin, for example, are more likely than light- skinned women to form keloids - an area of raised, sometimes itchy or painful, scar tissue. In addition, smokers and women with certain medical conditions - such as diabetes or any condition that requires use of certain kinds of steroids - can have poorer scar healing than other women, Cromi noted.

In this study, the majority of women in all four groups had developed “mature” C-section scars by the sixth month after delivery. That meant that the scar was light-colored and flat to the skin.

A similar percentage of women in each group had a more visible scar, with a line of red, raised skin that was confined to the site of the surgical incision. That included 39 percent of women who received staples, and between 34 percent and 44 percent of women who received the different types of suture.

The decision over how to close a C-section incision has traditionally been the surgeon’s. Staples are often favored because the method is faster than stitching, which may be better for patients, and protects the doctor from needle-stick accidents.

On the other hand, some women may prefer absorbable sutures since they do not have to be removed.

“I believe that the final decision about the choice of method and suture materials should be made balancing patient comfort…and surgeon judgment,” Cromi said.

SOURCE:  American Journal of Obstetrics & Gynecology, online April 26, 2010.

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