1 3 Arch Gynecol Obstet DOI 10.1007/s00404-014-3274-9 MATERNAL-FETAL MEDICINE A randomized controlled trial comparing cosmetic outcome after skin closure with ‘staples’ or ‘subcuticular sutures’ in emergency Cesarean section Chanderdeep Sharma · Ashok Verma · Anjali Soni · Meghna Thusoo · V. K. Mahajan · Suresh Verma Received: 2 January 2014 / Accepted: 25 April 2014 © Springer-Verlag Berlin Heidelberg 2014 are comparable in two groups. However, staples are asso- ciated with significantly increased duration of hospi- tal stay. Trial registered in clinical trial registry CTRI: REF/2013/05/005087. Keywords Cesarean · Cosmesis · Staples · Subcuticular · Sutures · Emergency · Skin closure Introduction Cesarean section (CS) is a common surgical procedure performed worldwide and the trend has been increasing across countries [1]. Although the procedure for CS itself has been more or less standardized, consensus on wound closure techniques remains elusive. Wound closure after CS with surgical metallic staples and subcuticular absorb- able sutures are the two most investigated methods among all available options. However, there is an overall paucity of evidence in terms of optimal skin closure technique as is apparent from the statement ‘skin closure techniques after CS demand further studies’ in a recent meta-analysis [1]. Even the recent Cochrane review [2] has provided no con- clusive evidence regarding optimal skin closure technique after CS. There is also lack of agreement among obstetri- cians for methodology for adequate cosmetic assessment of scar after CS as varied methods have been employed by different workers ranging from patient satisfaction sur- vey, point assignment by patient, digital photographic evaluation, Visual Analogue Score(VAS) and Patient and Observer Scar Assessment Scale (POSAS) for this purpose [3–9]. This study compares the cosmetic outcome after skin closure with two commonly used methods, ‘surgical metallic staples’ and ‘continuous absorbable subcuticu- lar sutures’ with 3-0 Monocryl, after emergency Cesarean Abstract Objective To compare staples with subcuticular sutures for skin closure in emergency Cesarean sections (CS). Methods One hundred and thirty women (undergoing emergency CS without previous abdominal delivery) were randomly assigned to either staples or subcuticular skin closure (monocryl 3-0). Primary outcome of the study was cosmetic outcome [as assessed by patient and independ- ent observer: Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS), respectively], 6 weeks post-operative. Secondary outcomes were wound complications, operating time, post-operative pain (visual analogue scale day 3 post-operative and patient assessment of pain in scar 6 weeks post-operative), and duration of hospital stay. Results 112 women were available for evaluation of scar 6 weeks post-operative. Cosmetic result of staples was significantly better than subcuticular sutures (PSAS and OSAS: p value 0.022 and 0.000, respectively), with sig- nificantly lesser duration of surgery (24 vs. 32 min: p value 0.000) and comparable post-operative pain (pain on day 3 and 6 weeks post-operatively: p value 0.474 and 0.179, respectively) and wound complications (p value 0.737). However, duration of stay in hospital was increased (6 vs. 3 days: p value 0.001). Conclusion Staples are the method of choice for skin clo- sure in emergency CS as they are significantly better than subcuticular sutures with respect to cosmesis and duration of surgery. Post-operative pain and wound complications C. Sharma (*) · A. Verma · A. Soni · M. Thusoo · V. K. Mahajan · S. Verma Dr RPGMC Kangra at Tanda (H.P.), Set No. 112, Vivekanand Hostel, Kangra 176001, HP, India e-mail: cdsharma2006@gmail.com