Comparison of Surgical Site Infections Using Absorbable and Non-Absorbable Sutures during Skin Closure in Patients Undergoing Caesarean Section

Abstract

Background: Cesarean section (CS) is the most frequently performed surgical procedure worldwide. Surgical site infections (SSIs) become a source of additional maternal morbidity after this surgery. Different surgical techniques and materials influence the risk of developing SSI. The existing body of literature does not prioritize one suture material over the other for skin closure during CS.

Aim: To determine the rates of SSIs between patients undergoing subcuticular skin closure during CS using absorbable (polyglactin) or non-absorbable (polypropylene) suture materials.

Methodology: This randomized clinical study was conducted in the Department of Obstetrics and Gynecology of Federal Government Polyclinic (FGPC) Hospital, Islamabad from 1^st April, 2025 to 30^th September, 2025. Two hundred and one eligible gravid females were randomized into groups of absorbable (A; n=100) and non-absorbable (B; n=101) skin closure groups. The randomization method employed was alternating suture material type every other day. Group A patients underwent skin closure using polyglactin 2-0 in a subcuticular running manner, whereas those of group B received subcuticular skin closure with polypropylene 2-0 suture. Subsequently, they were prospectively followed until the 10^th postoperative day for the development of SSIs and their signs (redness, pus discharge, and swelling).

Results: The mean age of the population was 28.32 ± 5.46 years, the median parity was 2, and the mean BMI was 24.26 ± 3.39kg/m². The rates of SSI were 7% in group A and 18.8% in group B (odds ratio [OR] 3.078, 95% confidence interval [CI] 1.232 - 7.694, p=0.013). The group A patients with SSIs showed erythema and swelling in 42.8%, compared to 78.9% (p=0.003) and 73.7% (p=0.006) in group B.

Conclusion: Patients with skin incision closure by absorbable suture had not only a low risk of SSI, but also a lower severity of wound infection. Hence, we recommend preferring the absorbable suture material over the non-absorbable for this purpose.

Keywords: SSI, Prolene^©, Vicryl^©, Cesarean section