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Abstract

Background: Surgeons worldwide perform C-sections more often than almost any other procedure, a trend that shows a steady and ongoing increase. Despite its safety profile, postoperative wound complications remain a significant source of maternal morbidity, prolonged hospitalization, and increased healthcare costs. Optimal skin closure technique following Pfannenstiel incision remains controversial, particularly regarding the choice between absorbable braided and non-absorbable monofilament sutures.

Objective: To compare wound morbidity and surgical outcomes following Pfannenstiel skin closure using polyglactin 910 (Vicryl) versus polypropylene (Prolene) in women undergoing cesarean delivery.

Methods: This prospective randomized controlled trial included 200 women undergoing elective or emergency cesarean section at a tertiary teaching hospital. Participants were randomly allocated into two equal groups: Vicryl (n = 100) and Prolene (n = 100) for subcuticular skin closure. The primary outcome was composite wound complication within 30 days, including surgical site infection (SSI), seroma, hematoma, wound dehiscence, or gaping. Secondary outcomes included operative time, estimated blood loss, postoperative pain, wound edge inversion, cosmetic outcome assessed using the modified Hollander wound evaluation scale, and patient satisfaction. Statistical analysis was performed using Student’s t-test and Chi-square test, with significance set at p < 0.05.

Results: Baseline demographic and obstetric characteristics were comparable between groups. Mean operative time was significantly shorter in the Prolene group compared with the Vicryl group (44.66 ± 4.33 vs 54.90 ± 4.87 minutes; p < 0.001). Estimated intraoperative blood loss was also significantly lower with Prolene (p < 0.001). Postoperative pain occurred more frequently in the Vicryl group (27% vs 14%; p = 0.036). Seroma formation (7% vs 1%; p = 0.037) and wound edge inversion (8% vs 0%; p = 0.004) were significantly higher in the Vicryl group. Rates of inflamed wound and wound gaping were not significantly different. Cosmetic outcomes were satisfactory and comparable in both groups.

Conclusion: Polypropylene (Prolene) for Pfannenstiel skin closure during cesarean section is associated with shorter operative time, reduced blood loss, and lower early wound morbidity compared with polyglactin 910 (Vicryl). These findings support the preferential use of monofilament non-absorbable sutures to optimize surgical efficiency and early postoperative outcomes.

Article Type

Original Study

Subject Area

Obstetrics and Gynecology

IRB Number

HM000192

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

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