Comparable cesarean incision infection following Vicryl versus Monocryl skin closure

1. There was no significant difference in cesarean incision infections or wound complications following subcuticular skin closure with Vicryl versus Monocryl suture.

Evidence Rating Level: 2 (Good)

Study Rundown: Nearly one-third of all deliveries in the United States end in a cesarean section, and roughly 10 percent of these are complicated by wound infections. Not only does infection present a burden to patients and their health, it’s also costly and resource taxing to the healthcare system. There is robust evidence that subcuticular skin closure with suture results in lower rates of wound complications compared to staple closure. However, the optimal type of suture closure has yet to be determined. Two of the most commonly used sutures are Vicryl, which is a braided synthetic multifilament, and Monocryl, a synthetic monofilament. Animal studies suggest that multifilament sutures materials may affect a higher risk for wound infection, but there have been few studies in humans. In this study, researchers performed a secondary analysis of a randomized trial of surgical site skin preparation to test whether suture type impacts incidence of wound infection.

Results demonstrate no significant difference in wound infections or complications between incisions closed with Vicryl versus Monocryl suture. A major strength of this study is the prospective data collection, however since suture type was up to physician choice, the results may still be skewed by confounding by BMI, surgeon preference or other factors. Moreover, this was a high-risk population—over 66 percent were obese—so wound complication rates overall were high and findings may not be generalizable to an average risk population. Future, prospective trials randomizing women on the basis of BMI and cesarean number are warranted to further explore whether suture type affects infection risk after cesarean delivery.

Click to read the study in AJOG

Relevant Reading: Comparison of Efficacy of Three Suture Materials, i.e., Poliglecaprone 25, Polyglactin 910, Polyamide, as Subcuticular Skin Stitches in Post-Cesarean Women

In-Depth [prospective cohort study]: In a secondary analysis of a randomized trial comparing cesarean surgical site infection rates following two different types of skin preparation, researchers compared women with low transverse skin incisions closed with 4-0 Monocryl (n = 691) versus 4-0 Vicryl suture (n = 180). The primary outcome was superficial or deep surgical site infection within 30 days, while the secondary outcome was other wound complications, including skin separation, seroma, hematoma, and cellulitis. The final multivariate model was adjusted for skin prep type, scheduled vs. unscheduled cesarean, and presence of subcutaneous layer closure.

There was no difference in surgical site infection rates between Vicryl and Monocryl incision closure (6.1% vs. 5.1%, p = 0.58, aOR: 1.23, 95%CI: 0.60-2.49). There were no significant differences in rates of other wound complications. Suture type did not differ significantly between women randomized to chlorhexidine-alcohol versus iodine-alcohol skin preparation (51.1% Vicryl vs. 49.4% Monocryl, p = 0.67).

Image: PD

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