The cosmetic outcome of the scar formation after cesarean section: percutaneous or intracutaneous suture?

Three methods of skin closure after cesarean section were tested and compared in a prospective trial. Eighty‐nine (82.5%) appeared for follow‐up investigation 4–5 months after delivery. The mean scar width was significantly narrower after phannenstiel incision compared with percutaneous nylon sutures after lower midline incision, 3.1 mm versus 11.3 mm. Intracutaneous continuous PDS‐suture after lower midline incision produced scars 40% narrower than with percutaneous sutures, 6.8 versus 11.3 mm. 37.5% of the women sutured intracutaneously complained over persistent secretion after discharge from the hospital. Some of these complaints were probably due to the introduction of new materials and skin closure technique. None consulted a physician with their complaints, i.e. the complications were sub‐clinical. Exclusion of the women with persistent secretions from the material led to significantly narrower scars compared with percutaneous closure, 4.5 versus 11.1. Thus, even better results can be expected as experience with the technique increases. Observer and patient satisfaction with the cosmetic outcome were measured independently on a ‘Lasa‐line’. Their opinions coincided; the order of acceptability was worst with percutaneous wound closure after lower midline incision, next best with intracutaneous closure after lower midline incision, and best after phannenstiel incision with intracutaneous closure.