Comparison of No Subcutaneous Closure, Interrupted Closure, and Continuous Non-locking Closure at Elective Cesarean Delivery
Phase: NA
Conditions: Post Operative Wound Infection, Suture, Suture Techniques, Ceserean Section
Sponsor: Yuzuncu Yil University

Document Title: Methods Summary (for ClinicalTrials.gov): Subcutaneous Tissue Closure 
Techniques in Elective Cesarean Delivery 
Document Date (Last Updated): 28 February 2026 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Study Design and Setting 
This was a single-center, prospective, parallel-group interventional study conducted in the 
Department of Obstetrics and Gynecology, Dursun Odabaşı Medical Center, Van Yüzüncü Yıl 
University, between 30 March 2022 and 20 October 2022. The study compared three predefined 
subcutaneous tissue closure strategies during elective cesarean delivery. 
Participants 
Adults scheduled for elective cesarean delivery were screened for eligibility. Written informed 
consent was obtained prior to participation. 
Inclusion Criteria 
• 
Age 18 years or older 
• 
Undergoing elective cesarean delivery 
• 
Subcutaneous adipose tissue thickness ≥ 2 cm 
• 
Provision of written informed consent 
Exclusion Criteria 
• 
Conditions associated with impaired wound healing (e.g., diabetes mellitus, autoimmune 
disease) 
• 
Chorioamnionitis, premature rupture of membranes, or other active infection 
• 
Current systemic steroid use 
• 
Refusal to participate 
Surgical Technique and Interventions 
All cesarean deliveries were performed via Pfannenstiel incision. The intervention was the 
method of subcutaneous adipose tissue management performed immediately prior to routine skin 
closure. The three study groups were: 
• 
Group 1 (No subcutaneous suturing): no approximation of the subcutaneous adipose 
tissue prior to skin closure. 
• 
Group 2 (Interrupted closure): approximation using three interrupted subcutaneous 
sutures placed along the incision prior to skin closure. 
• 
Group 3 (Continuous non-locking closure): approximation using a single-layer 
continuous, non-locking running subcutaneous suture along the incision prior to skin 
closure. 
Allocation 
Participants were assigned in a 1:1:1 ratio (n = 100 per group) using a sequential repeating order 
based on the order of surgery (non-randomized allocation). 

Data Collection and Variables 
Demographic and obstetric variables were recorded at baseline. Operative variables included: 
• 
Total operative duration (minutes) 
• 
Subcutaneous tissue length (cm) 
• 
If present, size of intraoperative subcutaneous fluid collection (cm) 
Postoperative Assessments and Outcomes 
Participants were followed through postoperative day 10. 
On postoperative day 10, wound outcomes were assessed using: 
1. Standardized clinical incision examination for findings consistent with wound infection 
(e.g., discharge, dehiscence, erythema, warmth). 
2. Incision-site ultrasonography to evaluate wound-related findings, including subcutaneous 
fluid collection and other complications (e.g., abscess, hematoma, cavity formation). 
Both assessments were performed using a predefined protocol; participants were blinded to 
group allocation. 
Statistical Analysis 
Analyses were performed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA). 
Continuous variables were summarized as mean ± standard deviation or median (interquartile 
range), and categorical variables as number (percentage). Normality was assessed using the 
Kolmogorov–Smirnov test. Between-group comparisons were performed using the Kruskal–
Wallis test for continuous variables and Pearson chi-square test for categorical variables. Within-
group comparisons across time points were evaluated using the Wilcoxon signed-rank test (two 
time points) or the Friedman test (three time points). Post-hoc pairwise comparisons were 
adjusted using Bonferroni correction where applicable. A two-sided p-value < 0.05 was 
considered statistically significant. 
Ethics 
Ethics approval was obtained from the Van Yüzüncü Yıl University Academic Ethics Committee 
on 30 March 2022 (Decision No: 07). All participants provided written informed consent.