Skin wound closure outcome using tissue adhesive versus subcuticular absorbable suture at elective caesarean section in dark-skinned women: A randomized controlled trial

Background Skin wound closure is an integral step of caesarean section. Various skin wound closure techniques have been used. However, there is no definite evidence regarding the ideal method for skin closure during Caesarean section. This study, therefore, aimed to compare the use of tissue adhesives with subcuticular absorbable sutures for skin wound closure and to determine patient satisfaction and cosmetic outcomes with each technique. Methods This was a two-arm single-blinded superiority randomized controlled trial. Women who had undergone elective cesarean section and met the inclusion criteria were recruited from the antenatal clinic of the University College Hospital, Ibadan. The participants were randomized into either skin closure with Dermabond tissue adhesive (intervention) or Vicryl 2/0 sutures (control). A total of 192 participants were randomized in the study, with 96 participants in each arm. Results A total of 185 participants completed the study (Control-92, intervention-93) and were included in the analysis. The mean age of the participants was 32.4 (SD ± 5.37) years. Approximately 88.9% of the participants had above the primary level of education, mostly Yoruba, by tribe. The patients’ assessment of the cosmetic outcome of their surgical wound was significantly better for tissue adhesives (p = 0.008), whereas there was no difference when it was assessed by the plastic surgeon (p = 0.50) via the findings from the POSAS. Additionally, there was no significant difference in patient satisfaction with their scar following each closure technique (p = 0.27). The additional analgesia requirement in the first 24 hours after surgery (p < 0.001) and the duration of skin wound closure (3.32 min ± 2.27 for tissue adhesives; 6.52 min ± 2.97 for sutures; p < 0.01) were significantly lower in the tissue adhesive group. There was no significant difference in the rate of wound complications between the groups. Conclusion The cosmetic outcome and patient satisfaction with tissue adhesive are not superior to those with the use of subcuticular sutures. However, pain control and the speed of skin wound closure were significantly better with tissue adhesives. Trial Registration Trial registration was performed online via the Pan African Clinical Trials registry at https://pactr.samrc.ac.za and was retrospectively registered with the registration number PACTR202308768448394. Registered on 14th August 2023. Details of the study data and protocol can be accessed from the corresponding author.