Subcutaneous tissue closure and postoperative wound complications in cesarean delivery: a systematic review and meta-analysis.

Summary

This meta-analysis of eight RCTs (n=1,854) found no significant reduction in surgical site infection, wound dehiscence, seroma, hematoma, or composite wound outcomes with routine subcutaneous tissue closure at cesarean in unselected patients. Low heterogeneity supports the robustness of the null effect; future work should refine patient selection and assess long-term cosmetic outcomes.

Key Findings

• Across 8 RCTs (n=1,854), no significant differences in SSI (RR 0.95, 95% CI 0.69–1.31), dehiscence (RR 0.64, 95% CI 0.21–1.98), seroma (RR 0.87, 95% CI 0.05–14.81), or hematoma (RR 0.54, 95% CI 0.02–15.90).
• Composite wound outcomes did not differ (RR 1.05, 95% CI 0.80–1.38).
• Between-study heterogeneity was low (I² < 45%), supporting the consistency of findings.

Clinical Implications

Avoid routine subcutaneous closure for cesarean patients with subcutaneous thickness <2 cm; individualize based on patient factors and consider evaluating long-term cosmetic outcomes in selected groups.

Limitations

• Excluded populations with subcutaneous fat >2 cm or obesity; findings may not generalize to higher-risk groups.
• Cosmetic outcomes and pain were secondary and variably reported, limiting conclusions beyond early wound complications.

Future Directions

Define patient subgroups that may benefit (e.g., by subcutaneous thickness strata), standardize cosmetic outcome measures, and assess cost-effectiveness.