الفهرس 
ANATOMY OF THE ANTERIOR ABDOMINAL WALLOnly 14 pages are availabe for public view
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Abstract
Many methods are available to the surgeon for apposition of wounds, including the use of non-suture materials (e.g., staples, adhesives, and clips) as well as a variety of suture materials and methods. The ideal closure for surgical incisions should be fast and easy to perform, provide optimal wound apposition with sufficient but not excessive tension, and offer a satisfactory cosmetic result for the surgeon and the patient.
This is a prospective randomized controlled study performed in Ain Shams University Maternity Hospital in the period from April 2012 till October 2012.
A total of two hundred women were randomly divided into subcuticular group (n=100) and stapler group (n=100) according to skin closure at cesarean delivery. Only those patients who were eligible were enrolled in the study.Our primary outcome measure was a composite wound morbidity outcome (including wound disruption or infection) and our secondary outcomes included cosmosis, post-operative pain, cost, procedure time, and patient satisfaction. Patients who were not eligible were excluded from the study.
This study showed no significant difference between subcuticular group and stapler group as regarding age, gestational age, parity, weight, height, body mass index,length of the scar and hospital stay. But there was significantly shorter operation time and there was a highly significant shorter time in skin closure in subcuticular compared to stapler group closure time of the skin in stapler group
The present study found that there was less post operative pain if wound was closed by subcuticular sutures when compared to staples after 48 hours and at the post operative week six by using visual analogue scale Our study also showed that staples were associated with increased peripartum medication use of opiate and non opiate drugs .
Our study showed that staples were associated with increased rates of wound infection ,wound separation, peripartum medication use of antibiotics for wound care, office visits before postpartum visit and office visits for staple removal .
The present study showed that there was no significant difference between subcuticular group and stapler group as regarding peripartum medication use of prophylactic antibiotics. It also showed that there was no significant difference between subcuticular group and stapler group as regarding readmission for wound care, readmission for any reason, office visits for routine wound check or office visits for wound problem.
According to our study there was no significant difference between subcuticular group and stapler group as regarding wound separation management either by secondary intention with packing, secondary intention without packing, reclosed with adhesive strips, reclosed with absorbable sutures or reclosed with staples.
In this study incisions closed with subcuticular suture were found to be more cosmetically appealing to patients by using Vancouver scale including vascularity, pigmentation, pliability, height.
In our study we found that satisfaction was decreased in stapler group . Occurance of wound complications is the most important factor that influenced patient satisfaction.
In Conclusion this study showed that the use of stapler for cesarean delivery closure is associated with an increased risk of wound complications. Occurrence of wound complications is the most important factor that influenced patient satisfaction .However more studies are needed on larger number of subjects to confirm these results.