Skin Closures at Cesarean Delivery, Glue vs Subcuticular Sutures.

NCT ID: NCT04371549

Last Updated: 2022-11-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

79 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-08-25

Study Completion Date

2021-03-01

Brief Summary

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The optimal choice of skin closure at cesarean delivery has not yet been determined. This study will compare wound complications and scar healing following cesarean delivery between 2 methods of skin closure: glue (Dermabond®; Ethicon, Somerville, NJ) and monofilament (Monocryl®; Ethicon) epidermal sutures.

Detailed Description

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Cesarean delivery (CD) rates have increased during the last few decades and it has become the most common surgery during women's reproductive years . However, despite its prevalence, data regarding many aspects of the preferred surgical technique are sparse. Skin closure is an integral step of CD. It influences postoperative pain, wound healing, cosmetic outcome, and surgeon and patient satisfaction There is currently no definite evidence regarding the best method for skin closure after cesarean delivery. Staples have been suggested as inferior to other techniques . Given the conflicting data available, obstetricians are forced to base their decisions on personal preference. Dermabond® glue (Ethicon Inc, Somerville, NJ) is a liquid monomer that forms a strong tissue bond with a protective barrier that adds strength and inhibits bacteria. An in vitro study found that glue inhibits both gram-positive (methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis) and gram-negative (Escherichia coli) bacteria . In addition, glue has the potential advantages of rapid application and repair time. It has been shown to achieve cosmetically similar results compared to staples within 12 months of the repair. Also, glue was shown to be well-accepted by patients .

To date, there have been no randomized clinical trials comparing skin closure with glue to sutures using the Patient and Observer Scar Assessment Scale (POSAS). The POSAS is a validated and reliable instrument that is practical for assessing scars . It is comprehensive and correlates well with patient ratings. The Observer Scar Assessment Scale rates 5 variables: vascularity, pigmentation, thickness, relief, and pliability. Each variable is ranked from 1-10, with 1 representing normal skin. Ratings are summed to obtain a total score ranging from 5-50. The Patient Scar Assessment Scale consists of 6 items: scar-related pain, itchiness, color, stiffness, thickness, and irregularity. Each item is ranked from 1-10, with 1 representing normal skin. Total score ranges from 6-60.

Previous studies regarding skin closure with glue were small, retrospective, and included mixed populations and varying surgical techniques. Therefore, clear, conclusive recommendations are lacking.

Dermabond® is a liquid monomeric (2-octyl cyanoacrylate) formulation that undergoes an exothermic reaction upon exposure to moisture, changing to polymers that form a strong tissue bond. The wound will not be dressed with an abdominal pad or adhesive tape according to manufacturer's instructions.

Conditions

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Cesarean Wound; Dehiscence

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Glue

Skin closure after cesarean section using glue

Group Type ACTIVE_COMPARATOR

Glue (Dermabond®; Ethicon, Somerville, NJ).

Intervention Type PROCEDURE

Arm 1: Skin after cesarean section will be closed by glue

Monocryl

Skin closure after cesarean section using running subcuticular sutures using synthetic monofilament

Group Type ACTIVE_COMPARATOR

Monocryl

Intervention Type PROCEDURE

Arm 2: Skin after cesarean section will be closed by running subcuticular sutures using synthetic absorbable monofilament

Interventions

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Glue (Dermabond®; Ethicon, Somerville, NJ).

Arm 1: Skin after cesarean section will be closed by glue

Intervention Type PROCEDURE

Monocryl

Arm 2: Skin after cesarean section will be closed by running subcuticular sutures using synthetic absorbable monofilament

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Maternal Age: 20-40 years old.
* BMI: 18.5 - 29.9 kg/m2.
* Gestational Age: term pregnancy (≥ 37 weeks) and viable fetus.
* Scheduled to undergo elective lower segment CD (category 4 CD).
* Hemoglobin level: ≥ 10 gm/dl.

Exclusion Criteria

* Abnormal placental invasion (e.g., placenta previa).
* Emergency CD (category 1, 2 and 3 CD).
* Clinical signs of infection at the time of CD.
* Medical disorder (Diabetes, Hypertension, Cardiac, Hepatic or renal disorder).
* Uterine anomalies (e.g., septum, Mullerian anomalies or fibroids).
* Previous CD not using Pfannenstiel method (e.g., midline incision).
* Known hypersensitivity to any of the suture materials or glue used in the protocol, or any disorders requiring chronic corticosteroids or immune suppressants.
* History of surgical site infection after previous CD.
Minimum Eligible Age

20 Years

Maximum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Ain Shams Maternity Hospital

OTHER

Sponsor Role lead

Responsible Party

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Ahmed Mohammed Elmaraghy

Lecturer of obstetrics and gynecology - faculty of medicine - Ainshams university

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mahmoud K Mohammed, M.B.B.Ch

Role: PRINCIPAL_INVESTIGATOR

AinShams university

Locations

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AinShams university maternity hospital

Cairo, , Egypt

Site Status

Countries

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Egypt

References

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Altman R, Bosch B, Brune K, Patrignani P, Young C. Advances in NSAID development: evolution of diclofenac products using pharmaceutical technology. Drugs. 2015 May;75(8):859-77. doi: 10.1007/s40265-015-0392-z.

Reference Type BACKGROUND
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ACOG Practice Bulletin No. 199 Summary: Use of Prophylactic Antibiotics in Labor and Delivery. Obstet Gynecol. 2018 Sep;132(3):798-800. doi: 10.1097/AOG.0000000000002834.

Reference Type BACKGROUND
PMID: 30134418 (View on PubMed)

Bhende S, Rothenburger S, Spangler DJ, Dito M. In vitro assessment of microbial barrier properties of Dermabond topical skin adhesive. Surg Infect (Larchmt). 2002 Fall;3(3):251-7. doi: 10.1089/109629602761624216.

Reference Type BACKGROUND
PMID: 12542926 (View on PubMed)

Blanchette H. The rising cesarean delivery rate in America: what are the consequences? Obstet Gynecol. 2011 Sep;118(3):687-690. doi: 10.1097/AOG.0b013e318227b8d9.

Reference Type BACKGROUND
PMID: 21860302 (View on PubMed)

Bruns TB, Worthington JM. Using tissue adhesive for wound repair: a practical guide to dermabond. Am Fam Physician. 2000 Mar 1;61(5):1383-8.

Reference Type BACKGROUND
PMID: 10735344 (View on PubMed)

Clay FS, Walsh CA, Walsh SR. Staples vs subcuticular sutures for skin closure at cesarean delivery: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol. 2011 May;204(5):378-83. doi: 10.1016/j.ajog.2010.11.018. Epub 2010 Dec 31.

Reference Type BACKGROUND
PMID: 21195384 (View on PubMed)

Cromi A, Ghezzi F, Gottardi A, Cherubino M, Uccella S, Valdatta L. Cosmetic outcomes of various skin closure methods following cesarean delivery: a randomized trial. Am J Obstet Gynecol. 2010 Jul;203(1):36.e1-8. doi: 10.1016/j.ajog.2010.02.001. Epub 2010 Apr 24.

Reference Type BACKGROUND
PMID: 20417924 (View on PubMed)

Daykan Y, Sharon-Weiner M, Pasternak Y, Tzadikevitch-Geffen K, Markovitch O, Sukenik-Halevy R, Biron-Shental T. Skin closure at cesarean delivery, glue vs subcuticular sutures: a randomized controlled trial. Am J Obstet Gynecol. 2017 Apr;216(4):406.e1-406.e5. doi: 10.1016/j.ajog.2017.01.009. Epub 2017 Jan 30.

Reference Type BACKGROUND
PMID: 28153666 (View on PubMed)

Draaijers LJ, Tempelman FR, Botman YA, Tuinebreijer WE, Middelkoop E, Kreis RW, van Zuijlen PP. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004 Jun;113(7):1960-5; discussion 1966-7. doi: 10.1097/01.prs.0000122207.28773.56.

Reference Type BACKGROUND
PMID: 15253184 (View on PubMed)

Siddiqui DS, Lacuna EM, Chen HY, Chauhan SP. Skin closure of pfannenstiel incision with dermabond, staples, or suture during cesarean delivery: experience of a single attending. Am J Perinatol. 2013 Mar;30(3):219-24. doi: 10.1055/s-0032-1323583. Epub 2012 Aug 8.

Reference Type BACKGROUND
PMID: 22875661 (View on PubMed)

Singer AJ, Hollander JE, Quinn JV. Evaluation and management of traumatic lacerations. N Engl J Med. 1997 Oct 16;337(16):1142-8. doi: 10.1056/NEJM199710163371607. No abstract available.

Reference Type BACKGROUND
PMID: 9329936 (View on PubMed)

Singer AJ, Quinn JV, Clark RE, Hollander JE; TraumaSeal Study Group. Closure of lacerations and incisions with octylcyanoacrylate: a multicenter randomized controlled trial. Surgery. 2002 Mar;131(3):270-6. doi: 10.1067/msy.2002.121377.

Reference Type BACKGROUND
PMID: 11894031 (View on PubMed)

Truong PT, Lee JC, Soer B, Gaul CA, Olivotto IA. Reliability and validity testing of the Patient and Observer Scar Assessment Scale in evaluating linear scars after breast cancer surgery. Plast Reconstr Surg. 2007 Feb;119(2):487-94. doi: 10.1097/01.prs.0000252949.77525.bc.

Reference Type BACKGROUND
PMID: 17230080 (View on PubMed)

van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP. Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale. Plast Reconstr Surg. 2005 Aug;116(2):514-22. doi: 10.1097/01.prs.0000172982.43599.d6.

Reference Type BACKGROUND
PMID: 16079683 (View on PubMed)

Other Identifiers

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2

Identifier Type: -

Identifier Source: org_study_id

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