Eur J Plastic Surg 2010; 33:233 specific to that particular type of suture material. The relative risk (with 95% CI) was used to assess for wound complication. T1 - Comparison of Subcuticular Suture Type for Skin Closure after Cesarean Delivery. Coaptive film versus subcuticular suture: comparing skin closure time following identical, single-session, bilateral limb surgery in children. Closure of the skin after cesarean delivery with poliglecaprone 25 suture decreases the rate of wound complications compared with polyglactin 910 suture. Follow along and learn how it is done. Objective: To compare subcuticular sutures with staples for skin closure after cesarean delivery in a randomized trial in which each woman was her own control. The item(s) has been successfully added to ", This article has been saved into your User Account, in the Favorites area, under the new folder. Am J Infect Control 2008;36:309–32. By default, always use absorbable sutures when using this technique. Obstetrics & Gynecology130(3):521-526, September 2017. What does subcuticular suture mean? Different types of suture with videos. Types of suture materials When we use a suture material in the human body we are implanting a foreign tissue into a host. The suture is placed by inserting the needle perpendicular to the epidermis.Inserting it perpendicularly helps in a wider bite of deeper tissue to be included in the suture than at the surface leading to rapid wound healing. The study protocol was approved by the institutional review board and written informed consent was obtained from all women before enrollment. Buried suture. Comparison of Subcuticular Suture Type for Skin Closure After Cesarean Delivery: A Randomized Controlled Trial. Scrafford JD, Reddy B, Rivard C, Vogel RI. Am J Obstet Gynecol 2015;212:621. e1–10. Although the running subcuticular suture is well described in surgical textbooks, 1 the “four-step method” is unique in that it separates and quantifies each component. 2017 Dec;130(6):1387-1388. doi: 10.1097/AOG.0000000000002387. Registered users can save articles, searches, and manage email alerts. 4 Since then, 19 RCTs and one systematic review have been performed addressing skin closure techniques. Participants were randomized to one of two treatment groups for subcuticular closure of their Pfannenstiel skin incision: 3-0 poliglecaprone 25 suture or 4-0 polyglactin 910 suture. When we use a suture material in the human body we are implanting a foreign tissue into a host. More information: Abstract #35 Comparison of subcuticular suture type in post-cesarean wound complications: a randomized controlled trial, The Pregnancy Meeting, 2017. You are working in urgent care and you see a patient with a laceration pop up on your board. Meaning of subcuticular suture medical term. Obstet Gynecol. Techniques and materials for skin closure in caesarean section. 2016 Oct;215(4):490.e1-5. Hamilton B, Martin J, Osterman M, Curtin SC, Matthews TJ. doi: 10.1002/14651858.CD003577.pub3. None of these women had a wound complication. 148: Thyroid Disease in Pregnancy, by The American College of Obstetricians and Gynecologists. Suture compared with staple skin closure after cesarean delivery: a randomized controlled trial. From May 28, 2015, to August 5, 2016, 275 women were randomized to poliglecaprone 25 and 275 to polyglactin 910, of whom 520 (95%) were included in the final analysis: 263 in the poliglecaprone 25 group [of whom 231 (88%) actually underwent poliglecaprone 25 closure] and 257 in the polyglactin 910 group [of whom 209 (81%) actually underwent polyglactin 910 closure]. Skin preparation for prevention of surgical site infection after cesarean delivery: a randomized controlled trial. The randomization allocation was concealed in opaque, identical, sequentially numbered, sealed envelopes. All women received preoperative prophylactic intravenous antibiotics within 1 hour of skin incision. You may be trying to access this site from a secured browser on the server. The analysis was conducted according to the intention-to-treat principle. J Obstet Gynecol India 2014;64:14–8. Suture Types - There are two main types of suture. Note: wound dehiscence is a surgical complication in which a wound ruptures along surgical suture. what type of hernia is … 91-120 days. 91-120 days. Poliglecaprone 25 was associated with a significantly decreased rate of overall wound complications when compared with polyglactin 910, 8.8% compared with 14.4% (relative risk 0.61, 95% CI 0.37–0.99; P=.04). Seventeen patients (3%) were protocol breaches: eight were less than 37 weeks of gestation, five received a vertical skin incision, two had active urinary tract infections, one had a vaginal delivery, and one required a reoperation in which the subcuticular suture was replaced with staples (Fig. 4-0 Vicryl absorbable cutting needle. Data is temporarily unavailable. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The different types of suturing techniques include: Simple interrupted suture: It is the most common and simple form of suturing technique. Rather, the subcuticular suture is applied under the epidermis using either an absorbable suture or a non-absorbable suture leaving external knots at the far ends of the laceration or incision so that the suture can be removed easily. Surg 1991; 89:234 3. Vats U, Pandit Suchitra N. Comparison of efficacy of three suture materials, i.e., poliglecaprone 25, polyglactin 910, polyamide, as subcuticular skin stitches in post-cesarean women: a randomized clinical trial. may email you for journal alerts and information, but is committed 16. The subcuticular suture is one of the most commonly employed techniques for closure of wounds. Ngai IM, Van Arsdale A, Govindappagari S, Judge NE, Neto NK, Bernstein J, et al. 1. 2012 Sep 12;(9):CD003577. When groups were analyzed by actual suture received, 265 of 520 (51%) women received poliglecaprone 25 suture and 217 of 520 (41.7%) women received polyglactin 910 suture. A randomized controlled trial of early versus delayed skin staple removal following caesarean section in the obese patient. The running subcuticular suture is valuable in areas where tension is minimal, dead space has been eliminated, and the best possible cosmetic result is desired. The groups were similar in demographic characteristics, medical comorbidities, and perioperative characteristics. 70% at 7 days 40% at 14 days 12% at 21 days. The subcutaneous suture is similar to the interrupted sutures with buried knots, but it is placed in the depth of the tissue in a surgical or traumatic wound. 7. 16 Our study is specifically randomized for type of absorbable suture for Pfannenstiel incision closure. Four (7.8%) wound complications occurred in 51 cases closed via subcuticular Biosyn suture. Purpose: To compare early outcomes of skin closure with octyl cyanoacrylate skin adhesive versus subcuticular suture closure. Randomization was computer-generated through www.randomization.com with alternating block sizes of six and 10 before the first patient was enrolled. Conclusion: In subgroup analysis, there were no significant differences in wound complications when comparing scheduled cesarean deliveries (no labor) with cesarean deliveries after labor or when comparing by class III obesity (Appendices 1 and 2, available online at http://links.lww.com/AOG/A980). Closure of the skin after cesarean delivery with poliglecaprone 25 suture decreases the rate of cesarean wound complications compared with polyglactin 910 suture. Suture compared with staple skin closure after cesarean delivery: a randomized controlled trial. Surgical staples compared with subcuticular suture for skin closure after cesarean delivery: a randomized controlled trial. The primary outcome was a wound composite outcome of one or more of the following: surgical site infection, wound separation, hematoma, or seroma within the first 30 days postpartum. The MOVE-trial: Monocryl® vs. Vicryl Rapide™ for skin repair in mediolateral episiotomies: a randomized controlled trial. AU - Buresch, Arin M. AU - Van Arsdale, Anne. Corresponding author: Arin M. Buresch, MD, Kaiser Permanente, Viewridge Medical Offices, 5251 Viewridge Court, San Diego, CA 92123; email: [email protected]. J Obstet Gynecol India 2014;64:14–8. In the presence of comorbid factors, poliglecaprone is the non-absorbable suture materials for skin repair. 4. Chunder A, Devjee J, Khedun SM, Moodley J, Esterhuizen T. A randomised controlled trial on suture materials for skin closure at caesarean section: do wound infection rates differ? Types of Suture. Please enable scripts and reload this page. Absorption. Patient Demographics, Perioperative Information, and Medical Comorbidities, Study Outcomes (Intent-to-Treat Analysis), Study Outcomes by Actual Suture Used for Skin Closure. There are many types of suture patterns available to close the incisions and wounds encountered daily in veterinary practice.Selecting the appropriate type of pattern is important to achieve not only uncomplicated wound healing, but also good cosmetic appearance.However,the important factors that assist in the selection of the appropriate pattern are not always clear. Clipboard, Search History, and several other advanced features are temporarily unavailable. B-T ime consuming technique. NIH This website uses cookies. T2 - A Randomized Controlled Trial. An important part of surgery is knowing the various types of closures to perform. We speculate that this significant difference was the result of the lack of braiding in the poliglecaprone 25 suture that allowed for increased resistance to infection. What is subcuticular suture? USA.gov. The staple group had a lower rate of complications when compared with the suture group as a whole (P5.033) and when compared specifically with the V-Loc suture group (P5.017). Simple Interrupted Suture. First, you use the running subcuticular method as usual with a non-absorbable suture. subcuticular suture explanation free. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in This medical how-to video demonstrates how to do a subcuticular suturing technique. The far near, near far type of buried stitch results in better eversion of the wound edges. 2007;63(3):155-62. doi: 10.1159 /000096893. This stitch is often used to close fascial layers. Nuthalapaty FS, Lee CM, Lee JH, Kuper SG, Higdon HL III. Violet, monofilament, synthetic absorbable suture composed of polydioxanone comparable to PDS II TM. application of absorbable subcuticular suture was safe in pediatric ... Verbeken E, De Ridder D, et al. Tan et al. Our study also was not able to clearly identify the type of skin preparation that was used for each patient as a result of changes in medical record documentation during the study period. Since its utility is limited to fine-tuning epidermal approximation, 5-0 or 6-0 suture is often useful when adopting this technique. Obstet Gynecol. Their quoted wound complication rate was as high as 33%. 12. 70% at 7 days 40% at 14 days 12% at 21 days. NLM Both natural and synthetic materials are used to make these surgical threads. Corbacioglu Esmer A, Goksedef PC, Akca A, Akbayir O, Dagdeviren H, Turan GY, et al. Mota R(1), Costa F, Amaral A, Oliveira F, Santos CC, Ayres-De-Campos D. Author information: (1)Department of Obstetrics and Gynecology, S Joao Hospital, Porto, Portugal. Poliglecaprone 25 was associated with a significantly decreased rate of overall wound complications when compared with polyglactin 910, 8.8% compared with 14.4% (relative risk 0.61, 95% CI 0.37-0.99; P=.04). Sutures are surgical threads that are used for closing or stitching surgical incisions and wounds, so as to speed up the healing process. Figure 9. Please try again soon. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. + + Depending on the chosen technique variation, this technique may be used with either absorbable to nonabsorbable suture. Skin adhesive versus subcuticular suture for perineal skin repair after episiotomy--a randomized controlled trial. Gynecol Obstet Invest. Comparison of Subcuticular Suture Type for Skin Closure After Cesarean Delivery: A Randomized Controlled Trial. Corbacioglu Esmer A, Goksedef PC, Akca A, Akbayir O, Dagdeviren H, Turan GY, et al. They may either be continuous or interrupted. Suture types are broadly split into the following categories: Absorbable vs nonabsorbable; Braided vs non-braided; Natural vs synthetic; Types of suture materials. Some sutures are secured twice on each side, and the suture is planted deeper into body tissues. A scar assessment scale, which subjectively evaluates the recovery of surgical wounds, is an important evaluation tool. All P values were two-sided and a P value <.05 was deemed statistically significant. Demographic features, medical comorbidities, and known perioperative risk factors for cesarean incision complications were recorded (Table 1). Results: Mackeen AD, Khalifeh A, Fleisher J, Vogell A, Han C, Sendecki J, et al. In planned subgroup analyses, suture groups were stratified by scheduled cesarean delivery compared with cesarean after active labor, for body mass index as a categorical variable, and by actual suture type received. AU - Sun, Mengyang. Visit our ABOG MOC II collection. Suturing techniques: running subcuticular suture. If a patient is: ... Running Subcuticular Sutures . Anatomy a type of immovable joint, esp between the bones of the skull (cranial suture) 3. ClinicalTrials.gov, NCT02459093. To detect a reduction in the primary outcome rate from 12% to 4%, with a power of 0.90 and a two-tailed α of 0.05, 237 women per study group were required. There were no differences in analgesic use, wound complications, cosmesis or patient satisfaction. This HealthHearty write-up provides information on the types of sutures … Mackeen AD, Schuster M, Berghella V. Suture versus staples for skin closure after cesarean: a metaanalysis. Births: final data for 2014. What does subcuticular suture mean? One limitation of our study was the exclusion of emergency cesarean deliveries. Ethicon. Given the recognised association between vascular SSIs and adverse clinical … Patients undergoing nonemergent cesarean delivery at or beyond 37 weeks of gestation were randomized to undergo subcuticular skin closure with either poliglecaprone 25 or polyglactin 910. 10. HHS Role of subcutaneous closure in preventing wound complications after cesarean delivery with Pfannenstiel incision: a randomized clinical trial. You are working in urgent care and you see a patient with a laceration pop up on your board. Patients undergoing nonemergent cesarean delivery at or beyond 37 weeks of gestation were randomized to undergo subcuticular skin closure with either poliglecaprone 25 or polyglactin 910. Given this was a secondary analysis, essentially a prospective cohort study, there was a potential for selection bias and residual confounding. Cesarean incision closure with poliglecaprone 25 suture is associated with a significantly decreased rate of wound complications when compared with polyglactin 910 suture. The rate in which a suture dissolves is dependent upon the suture type, size, and location in the body where the suture is placed. To our knowledge, our study is the first to compare glue and subcuticular sutures in CD using POSAS. Cesarean delivery techniques followed the preference of the attending surgeon. The suture is placed by inserting the needle perpendicular to the epidermis.Inserting it perpendicularly helps in a wider bite of deeper tissue to be included in the suture than at the surface leading to rapid wound healing. The first is braided and non-braided, or monofilament. Effect of intra-operative glove changing during cesarean section on post-operative complications: a randomized controlled trial. Skin closures were generally performed by resident physicians with attending supervision. Comparison of Subcuticular Suture Type for Skin Closure After Cesarean Delivery: A Randomized Controlled Trial. AU - Sahasrabudhe, Nicole. This decision was made because informed consent could not be reliably obtained. The instruments also need to be correctly sterilised and handled carefully. 2020 Nov;136(5):972-980. doi: 10.1097/AOG.0000000000004120. The different types of suturing techniques include: Simple interrupted suture: It is the most common and simple form of suturing technique. … Objective: Monocryl (poliglecaprone 25) suture. The primary outcome was a wound composite outcome of one or more of the following: surgical site infection, wound separation, hematoma, or seroma within the first 30 days postpartum. Am J Obstet Gynecol 2016;215:490.e1–5. Comparison of suture materials for subcuticular skin closure at cesarean delivery. Clinical trial registration: Therefore, the running subcuticular suture is best reserved for wounds in which the tension has been eliminated with deep sutures, and the wound edges are of approximately equal thicknesses. All women received neuraxial analgesia: spinal, epidural, or combined spinal and epidural. It follows on, therefore, that a tissue reaction within the host should be expected, and can be either an advantage or a disadvantage. 2017 Sep;130(3):521-526. doi: 10.1097/AOG.0000000000002200. Subcuticular sutures also appear to reduce SSI rates. Vats and Pandit Suchitra5 compared two absorbable types of suture material in postcesarean wound complication and found poliglecaprone 25 to have statistically significant lower rates of swelling and induration, wound discharge, and wound dehiscence and increased wound healing when compared with polyglactin 910. Natl Vital Stat Rep 2015;64:1–64. synthetic absorbable suture an absorbable suture produced from strands of polymers; the most commonly used materials are polyglactin 910 (Vicryl) and polyglycolic acid (Dexon); the latter is more rapidly absorbed. Poliglecaprone 25 is a monofilament suture with an absorption profile of 91–119 days.12 Polyglactin 910 is a braided suture with an absorption profile of 56–70 days.13 Given the difference in profile for each suture and the physiologic wound healing process, we hypothesized that absorbable suture materials with differing profiles, poliglecaprone 25 suture and polyglactin 910 suture, may have different rates of wound complications. One needlestick injury occurred with suture. Tensile strength and host response towards silk and type i polypropylene implants used for augmentation of fascial repair in a rat model. Natl Vital Stat Rep 2015;64:1–64. 3. With the first step, the skin is gently everted using an Adson forceps to visualize the dermal-epidermal junction ( Fig. I wonder what type of suture I will use; how long should these sutures stay in for, what type of suture will I tie? https://lacerationrepair.com/wound-blog/the-subcuticular-finish J Obstet Gynaecol Res 2014;40:728–35. Am J Infect Control 2008;36:309–32. Analysis was performed according to the intent-to-treat principle. Types of sutures. During the telephone interview, each patient was asked about any wound complication, infection, or need for antibiotics since discharge from the hospital. The subcuticular suture technique is also known as intradermal suturing. Home Types of Suture ... Subcuticular closure; GI, spay/neuter; Not for use in cardiovascular, neurological, microsurgery or ophthalmic surgery; Wound Support. Tuuli MG, Stout MJ, Martin S, Rampersad RM, Cahill AG, Macones GA. Am J Obstet Gynecol. Using POSAS, they found equivalent cosmetic appearance of CD scars when comparing staples and subcuticular sutures. Suture Types and Indication. To compare the rate of wound complications among women who underwent cesarean delivery through a Pfannenstiel skin incision followed by subcuticular closure with either poliglecaprone 25 suture or polyglactin 910 suture. Surgery 1982;91:61–3. S Afr Med J 2012;102:374–6. What type of suture is used for short skin incisions such as laparoscopic port sites and pediatric incisions. subcuticular suture a method of skin closure involving placement of stitches in the subcuticular tissues parallel with the line of the wound. For more information, please refer to our Privacy Policy. Additionally, the study was underpowered to detect small differences in outcomes.16. That is to say, when done correctly, they give the best cosmetic outcome. 2. You start going through the files in your mind. DO. sisporto@med.up.pt OBJECTIVE: Surgical repair of perineal lesions after delivery is frequently … 1 , above, left ). Guyuron B, Vaughan C. A comparison of absorbable and 2. 30 mins. Odijk R, Hennipman B, Rousian M, Madani K, Dijksterhuis M, de Leeuw JW, van Hof A. BMC Pregnancy Childbirth. Role of subcutaneous closure in preventing wound complications after cesarean delivery with Pfannenstiel incision: a randomized clinical trial. Then, in the case group (n = 35), wound suturing was done using subcuticular suturing with an absorbable 4/0 monofilament monocryl suture supported by 3 Steri-Strips™ and in the control group (n = 35), suturing was done using 3 interrupted mattress sutures with a nonabsorbable 4/0 nylon sutures. Please enable it to take advantage of the complete set of features! Today we are going to discuss several of the many type of sutures as well as when they are indicated for use, suture material, and finally suture patterns that can be used. Benefits. Randomization resulted in groups that were generally similar in demographic characteristics, medical comorbidities, and perioperative characteristics (Table 1). 800-638-3030 (within USA), 301-223-2300 (international) Analysis was performed according to the intent-to-treat principle. Patients were excluded if they had a urogenital tract infection within 2 weeks before cesarean delivery, used systemic corticosteroids during their pregnancy for 2 weeks or greater, were younger than 18 years old, or if the surgical plan was for a vertical skin incision. The method of skin preparation has been shown in recent studies to have an effect on surgical site infection rates for obese patients at our institution.14 Additional limitations were the fairly high rate of protocol noncompliance (20% of enrolled patients did not receive their allocated suture type) and the potential differential effect of the suture bore size, 3-0 for poliglecaprone 25 suture and 4-0 for polyglactin 910 suture. Monofilament suture was shown to have a lower degree of infectibility when compared with multifilament suture in a mouse model, although poliglecaprone 25 suture was not included in the 16 types of suture that were studied. Postdelivery, the women and outpatient follow-up health care providers did not have knowledge of the subcuticular suture group participants were assigned. To compare the rate of wound complications among women who underwent cesarean delivery through a Pfannenstiel skin incision followed by subcuticular closure with either poliglecaprone 25 suture or polyglactin 910 suture. Registered users can save articles, searches, and manage email alerts. Types of Sutures. It provides longer-term support to the healing wound and improves the cosmetic result. Nov 29, 2014 - Looking for online definition of subcuticular suture in the Medical Dictionary? COVID-19 is an emerging, rapidly evolving situation. Financial Disclosure The authors did not report any potential conflicts of interest. Horan TC, Andrus M, Dudeck MA. Since its utility is limited to fine-tuning epidermal approximation, 5-0 or 6-0 suture is often useful when adopting this technique. Wolters Kluwer Health Crude and adjusted odds ratios were computed using the Mantel-Haenszel test and a test of homogeneity was performed to assess for evidence of effect modification. A running subcuticular suture is a buried form of a running horizontal mattress suture. Obstet Gynecol.  |  Types of Suture. Infect Control Hosp Epidemiol 2010;31:276–82. 2013 Jan;121(1):33-8. doi: 10.1097/aog.0b013e31827a072c. Obstet Gynecol 2014;123:1169–75. The two most widely used sutures for low-transverse cesarean skin incision closure in our institution are poliglecaprone 25 and polyglactin 910. But there is a lack of data comparing the outcome of different types of subcuticular suture materials. 8. suture 1. Running subcuticular sutures are considered to be the “holy grail” of suturing techniques by many. Although their study population was limited to emergent cesarean deliveries, the sample size was small, and the method of randomization was not explained. You start going through the files in your mind. Each author has indicated that he or she has met the journal's requirements for authorship. , Vogell a, Goksedef PC, Akca a, Willers D, Jauk VC, Szychowski,... Is Available in different sizes email along with your password to log in most widely used sutures for low-transverse skin... Cahill AG, Macones GA cdc/nhsn surveillance definition of health care-associated infection and criteria for specific types of in... Were generally similar in demographic characteristics, medical comorbidities, and perioperative.... Suture technique is primarily used to eliminate dead space they found equivalent cosmetic appearance of scars..., Andrews WW, Hauth J, et al the subcuticular suture for. This website you are working in urgent care and you see a patient is...! 11 ( 11 ): CD003577 all women before enrollment not be reliably obtained high 33. And type i polypropylene implants used for closing or stitching surgical incisions and,. - Bernstein, Peter S. AU - Garry, David J. PY - 2017/9/1 types and... To fine-tuning epidermal approximation, 5-0 or 6-0 suture is associated with a non-absorbable suture since its utility limited! Perfusion than all other closure patterns from a secured browser on the other hand, their. Widely used sutures for low-transverse cesarean skin incision closure in preventing wound complications with! Delivery units what can you place over an inverted interrupted suture: it is the non-absorbable materials.:... running subcuticular closure, which subjectively evaluates the recovery of surgical site infection and criteria for specific of. Recorded ( Table 1 ), 301-223-2300 ( international ) [ email protected ] provide significant wound,! Composed of polydioxanone comparable to PDS II TM can be used randomization was... Of health care-associated infection and criteria for specific types of subcuticular suture.. Perineal lesions after delivery is frequently … suturing techniques include: Simple interrupted suture and running subcuticular method usual! Delivery: a randomized controlled trial ):1387-1388. doi: 10.1097/AOG.0000000000002386 twice on each side and! That, they are certainly the most common and Simple form of suturing techniques include: Simple interrupted suture it. Surgery is knowing the various types of sutures that can be used, non absorbable, non,! Of infection in the acute care setting concealed in opaque, identical, sequentially numbered sealed! The recovery of surgical site infection after cesarean delivery: a randomized trial... Was a prospective cohort study, there was a secondary analysis, essentially a prospective cohort study, there a... First to compare glue and subcuticular sutures esp between the 5 suture pattern types have been performed skin... For longer than 60 days would be used with either absorbable to nonabsorbable suture Forest for Trees... Chauhan SP, Rouse DJ lower than all other closure patterns and our lost-to-follow-up rate was low “ holy ”! Journal articles are free through the files in your mind 910 suture Martin S, Judge,. Our incidence of wound complication 21 days outcome of different types of suture! ):1385. doi: 10.1097/AOG.0000000000002387 technique is primarily used to hold tension irrespective anatomic. Delivery technique: Seeing the Forest for the Trees Obstetricians and Gynecologists subcuticular suture type pediatric... Verbeken E De! Film versus subcuticular suture for Pfannenstiel incision: a randomized clinical trial, C. Ngai, Ivan M. AU - Buresch, Arin M. AU - ngai, Ivan M. AU - Arsdale. Grail ” of suturing technique is also known as intradermal suturing technique not... Randomization resulted in groups that were generally similar in demographic characteristics, medical comorbidities, and manage email.... ( cranial suture ) 3 a lack of data comparing the individual wound complications compared with polyglactin 910.. Materials when we use a suture material in the acute care setting USA. Biosyn suture obtained from all women received neuraxial analgesia: spinal, epidural, or combined spinal and.. Rapide™ for skin closure as well intra-operative glove changing during cesarean section on post-operative complications a!
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