Comparative Study Between Subcutaneous Tissue Closure Versus Drain in Obese Women Undergo Elective Cesarean Section
Condition: Wound Infection
MeSH terms: Wound Infection
Study type: Interventional

Summary: 
      Randomised cinical trial in demmita General Hospital.300 obese women pregnant with
      gestational age >38 wk ,theire age range from (25-35) years and BMI between (30 -40)
      undergoing elective cesarean section were randomised into 3 groups (100 patients in each
      group)and compare the role of subcutaneous tissue closure in post cesarean section wound
      complications.

      3groups are: A- interrupted closure of subcutaneous tissue without drain. B-interrupted
      closure of subcutaneous tissue with drain. C-non closure of subcutaneous tissue. All womenu
      nder going CS with Pfannenstiel incision were considered to be eligible if time allowed
      informed consent before the surgery
    

Detailed description: 
      Randomised cinical trial in demmita General Hospital.300 obese women pregnant with
      gestational age >38 wk ,theire age range from (25-35) years and BMI between (30 -40)
      undergoing elective cesarean section were randomised into 3 groups (100 patients in each
      group)and compare the role of subcutaneous tissue closure in post cesarean section wound
      complications.

      3groups are: A- interrupted closure of subcutaneous tissue without drain. B-interrupted
      closure of subcutaneous tissue with drain. C-non closure of subcutaneous tissue. All womenu
      nder going CS with Pfannenstiel incision were considered to be eligible if time allowed
      informed consent before the surgery All surgical procedures were performed by obstetric and
      gynecology residents under the supervision of attending physicians After the sequential
      closure of the uterus and peritoneum, the fascia was closed with 2-0 polyglactin 910
      (Vicryl). The depth of the subcutaneous adipose tissue was measured with a sterile ruler from
      the fascia to the skin edge at the middle of the superior aspect of the skin incision.Women
      with a subcutaneous tissue thickness of 4.0 cm or more were then formally enrolled and
      randomized to one of the two subcutaneous closure techniques. Subcutaneous hemostasis was
      achieved using electrocautery and skin was approximated

      with subcuticular suture using 2-0 polyglactin910 (VicrylRapide). In the drain group, a
      closed nonvacuum drain was inserted in the tissue and exited from the skin through a separate
      opening and stitched to the skin. The subcutaneous tissue was sutured. Cautery was used for
      hemostasis. The skin was closed with a continuous nonabsorbable polypropylene 2/0 (Acufirm;
      Ernst Kratz, Germany) subcuticular sutures. Operative time was estimated from the start of
      skin incision until the end of skin suturing. The drain was left until the drainage rate was
      less than 50 ml/day.

      All randomized women received standard postoperative wound care. Surgical dressing was
      removed on the first postoperative and all participants were discharged 24 h after the CS.
      The participants were invited to two follow-up in the first and second week post
      operativewith regard to postoperative pain, postoperative fever, hospital stay duration,
      wound infection, wound seroma, wound disruption, and the need for redressing. T he
      postoperative pain was judged after 24 h using visual analogue scale, in addition any time
      clinically indicated. Patients and physicians who assessed the incision postoperatively were
      blinded towards the study group. The data of the patients who did not attend hospital for
      examination were collected through telephone interview
    

Intervention name(s): Cesarean section; subcutanous sutures; subcutanous drain
Intervention type(s): Procedure; Procedure; Device
Intervention description(s): Abdominal Incision: Pfannenstiel incision Sharp dissection will be continued through the subcutaneous layer to the fascia.
The fascia will be then incised sharply at the midline
The transversalis fascia and pre peritoneal fat will be dissected carefully
The peritoneum will be then incised.
Low Transverse Cesarean Incision. Bladder flap creation effectively moves the bladder away from the planned hysterotomy site
Delivery of the Fetus and placenta.
Uterine Repair in two layers of continuous 0-or No.1 absorbable suture.; suture closure of subcutaneous tissue with interrupted 2-0 polyglactin 910 (Vicryl).the stitch interval is 1cm; Inthedraingroup,aclosednonvacuum drain willbeinsertedin thetissueandexitefrom theskinthroughaseparateopeningandstitchto theskin
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention