Cesarean section is a surgical procedure in which an incision is made in the mother’s abdomen and uterus to remove the baby. Once the uterus is empty and does not present tears or remains of the placenta, it is closed .
Currently there are various ways for this, so today we proceed to talk about the types of suture that exist at the time of performing a cesarean section , as well as the characteristics and care of each one.
Absorbable suture
As its name implies, the absorbable suture is one in which the thread is reabsorbed only with the passage of time. The body treats this type of suture as a foreign object, so the immune system generates an inflammatory response to dissolve or eradicate it.
This type of suture is used to close the uterus and the layers of tissue that were opened during the cesarean section (skin, subcutaneous fat, muscular aponeurosis and parietal peritoneum).
They can also be used externally, although they are usually used preferably only internally, since the absorbable suture can create more scars than the non-soluble ones. A plus point is that unlike non-absorbable sutures, absorbable sutures are much less likely to create reactions such as infections or granulomas.
The time it takes for absorbable sutures to dissolve can be from a couple of weeks to a few months, as it will depend on the material used (whether it is natural or synthetic) and the size of the suture.
Stitches or non-absorbable suture
Unlike the absorbable suture, which reabsorbs itself with the passage of time, the stitches or non-absorbable suture must be removed by the doctor on the date after the surgery that he indicates.
Like the absorbable suture, the thread for the stitches or non-absorbable suture can be made of natural or synthetic materials, and its structure can be monofilament (a single thread) or braided (several small threads braided together).
There are various techniques of suturing after a cesarean section , which will depend mainly on the choice of material, the size of the cut to be sutured and the skill of the doctor. Among them are:
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Suture with loose or discontinuous stitches. This technique uses several threads to close the wound: after making a stitch, the material is cut and tied. This technique leads to a tightly closed wound and if one of the stitches breaks, the rest of the stitches will hold the wound together.
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Continuous suture. This technique involves a series of stitches using a single thread. This type of suture can be placed quickly and is also strong, as the tension is evenly distributed throughout the running suture.
The stitches or sutures are usually removed 10 to 12 days after the cesarean section . It will be the midwife or gynecologist who will remove them in consultation, after having assessed the wound and its healing status. In case the wound has not yet healed completely, it is possible that only some point will be removed and you will be summoned to remove the rest after a few days.
Staples
Surgical staples came to replace in many cases the traditional stitches to close the caesarean section wound. Staples should also be removed by the doctor once the incision has healed.
One of the great advantages of staples lies in the speed to place them, considerably shortening the duration of the cesarean section , and in possible medical errors with the needle, although much also depends on the expertise of the surgeon. The first staples that were used left a lot more mark, but today the results are very similar to those of the points.
Staples are made of materials such as titanium or plastic, although currently it is also possible to find biodegradable ones based on polyester, which is reabsorbed in the body (used mainly in cosmetic surgery).
After the cesarean section, the staples will need to remain in place for a few days or up to three weeks in some cases. The time will depend on several factors , such as the size of the incision, if there were any complications in the wound, and how quickly it heals.
When a low transverse (horizontal) incision is made the staples can be removed in a matter of a week, while in a vertical incision they usually last 7 to 10 days or more.
As with the traditional suture, the midwife or gynecologist will remove the staples in consultation , after having assessed the wound and its healing status.
Glue or adhesive
Cyanoacrylate medical adhesives, also called skin glue or surgical glue , are an alternative to using traditional methods such as sutures or staples, and are relatively short-term to use.
This type of skin glue or adhesive takes less time and is painless. The doctor applies it over the incision, providing a protective covering that closes the wound. The glue gradually comes off on its own as the wound heals.
Surgical glue or adhesive has several advantages over traditional sutures and staples, in that in addition to not requiring the doctor to remove it, it protects the wound from dust and can reduce the appearance of scars.
The use of this type of closure after cesarean section will depend on its availability (not all hospitals handle it) and also on certain factors related to the surgery, such as the type and size of the incision.
What studies say about each type of suture
Given these options, surely a question comes to mind: which of all is better? This will really depend on several factors, but we can always talk with our doctor about the options, as we remember that each situation, each body, and each cesarean section is unique .
What we can do in the meantime is see what science and studies tell us about the different types of sutures used after cesarean section.
According to a 2015 study comparing absorbable versus nonabsorbable sutures , wound complication rates were similar. The main difference was in the time of closure (less in the absorbable suture) and the aesthetic result (the healing was visibly better in the non-absorbable suture).
Another 2014 study reviewed the complication rate of traditional and stapled sutures, finding that thread closure is associated with a 57% decrease in wound complications compared to staple closure.
On the same topic, a more recent study (2019) also found that staple use is associated with an increased risk of wound complications, as well as prolonged postoperative hospital visits.
On the other hand, a 2017 study on the differences between the traditional single-thread suture and the skin adhesive found that there were no significant differences between them in terms of infections and the duration of postpartum hospitalization or interruption of delivery. wound.
In this case, both methods were shown to be equally safe and successful in closing the skin after cesarean delivery and therefore can be used according to the preferences of the physician and the patient.
Photos | iStock
In Babies and more | Caesarean section scar care: what you need to know, Step by step caesarean section: how this operation takes place so that the baby is born
