Different ways of subcutaneous tissue and skin closure at cesarean section: a randomized clinical trial on the long-term cosmetic outcome.

OBJECTIVE: To study the effect of subcutaneous tissue closing and the effect of two different skin closure methods at cesarean section on long-term cosmetic results.

DESIGN: Randomized controlled trial.

SETTING: A large teaching hospital in the Netherlands.

POPULATION: Women undergoing a cesarean section.

METHODS: Women undergoing a cesarean section were assigned to subcutaneous tissue closure or not, and skin closure with staples or intracutaneous sutures. Operating time, postoperative pain and incidence of complications were recorded. Long-term cosmetic result was assessed 1 year postoperatively through the Patient and Observer Scar Assessment Scale (POSAS) and Numeric Rating Scale (NRS).

MAIN OUTCOME MEASURES: The POSAS for subjective and objective scar rating and the NRS to provide an overall opinion on appearance of the scar 1 year after surgery.

RESULTS: Of the 218 women randomized, data from 145 women could be analysed after 1 year of follow-up. No significant differences were detected in long-term cosmetic outcome between the different closure methods. Except for operating time, no differences in other secondary outcome measures were found.

CONCLUSIONS: At cesarean section, closing the subcutaneous tissue or not and using staples or intracutaneous sutures results in an equivalent long-term cosmetic appearance of the scar.