7. Comparison Of Alternative Techniques Of Closure Of Subcutaneous Fat During Caesarean Section

Rameshwari Choudhary, Kanti Yadav

ABSTRACT

Background: A large number of women undergo caesarean section throughout the world. These women pass through a period of post-operative pain and morbidity period. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load, but also help in early recovery of the patient. Objectives: The aim of this study is to compare the effects of alternative techniques for closure of subcutaneous fat on maternal health and use of health care resources in caesarean section. Materials and Methods: Patients undergoing Caesarean section were divided in two groups of one hundred patients each. Patients with hematological disorders or malignancy, diabetes, septicemia or chorioamnionitis were excluded from the study. In all the patients, after stitching the uterus, the rectus sheath was stitched with thread Vicryl No.1 using a round body needle. Then the patients were divided into two groups. In group I, Vicryl No.1 thread used in stitching of the rectus sheath was continued into the skin with the application of subcuticular stitches, after securing the edges with a knot. In group II, after stitching the rectus sheath with Vicryl No. 1, the thread was cut and interrupted sutures were applied in subcutaneous fat with thread Vicryl No. 2. Skin was stitched with subcuticular stitches using Vicryl no.1, the two groups of patients were observed for the duration of surgery, evidence of wound infection or seroma, and cosmetic results. Results: It was noted that the duration of surgery in group I was on average 4.15 minutes less as compared to the duration in group II, there was a significant decrease in wound infection, haematoma, seroma and wound dehiscence after fat closure wound infection was more common in patient with leaking >18hours. Conclusion: It was concluded that in spite of using the best closure technique and keeping in mind the patient related factors complication arising after CS are frequent and most commonly associated with non closure of fat. Further studies are needed for evaluation of ideal suture materials for closure of skin.

Key-words: Caesarean section, suture material, wound infection, subcutaneous fat.

[Full Text Article]