Dressing Versus Glue (2-Octyl Cyanoacrylate) for Coverage of the Skin Incision After Closure During Cesarean Delivery

March 9, 2015 updated by: Matthew Kim, Danbury Hospital

A Randomized Controlled Trial of Dressing Versus Glue (2-Octyl Cyanoacrylate) for Coverage of the Skin Incision After Closure During Cesarean Delivery

This study is investigating the relative risks and benefits of using two common materials for coverage of the skin incision at cesarean delivery. We will perform the first prospective and the first randomized controlled trial examining the use of a standard postoperative dressing versus skin glue for coverage of the closed skin incision after cesarean delivery. The hypothesis is that using skin glue for coverage of the incision will be associated with decreased wound complications and increased patient satisfaction.

Study Overview

Status

Withdrawn

Conditions

Intervention / Treatment

Detailed Description

Given the plethora of literature regarding technical aspects of performing cesarean delivery, and given the large number of procedures performed each year and available for prospective trials (approximately 700 cesarean deliveries per year at Danbury Hospital), only quality level I evidence is broadly considered influential in this area of research. Therefore we propose a RCT for incision coverage with dressing versus glue at cesarean delivery.

On admission to L&D for schedule cesarean section, or on admission to L&D for labor, patients will be asked to participate by a Trial Coordinator or the admitting Obstetrics and Gynecology resident physician. Patients admitted for labor will be asked to participate given the possibility that they may ultimately require cesarean delivery, and because using only patients admitted for scheduled cesarean delivery would eliminate urgent and emergent cesarean deliveries from the trial, and therefore decrease the generalizability of the trial results to general obstetrics practice.

When consented and the patient undergoes cesarean delivery, the patient's surgeon will decide if skin closure will be performed by placement of staples or suture. The circulating nurse in the OR will open one of a set of sequentially numbered, opaque sealed envelopes (SNOSE) to indicate the patient's allocation for coverage of the incision with a dressing or glue. The circulating nurse will then tell the surgeon to which group the patient has been allocated.

Before closure of the incision, care is taken to ensure hemostasis of the subcutaneous tissues and skin edges. If the subcutaneous tissues are > 2 cm thick, this tissue layer should be approximated before closure of the skin as is currently a level I evidence-based recommendation based on multiple RCTs and promoted by current clinical guidelines. Choice of suture material and needle for the running subcuticular closure, or use of staples for closure, are per the surgeon's preference.

If allocated to coverage with dressing, the standard dressing will be applied by a member of the surgical team in the standard fashion as follows: The closed incision will be covered first with a primary dressing consisting of a nonadherent, composite dressing (Telfa), which is covered with a secondary dressing consisting of an Army Battle Dressing (ABD), before removal of the sterile surgical drapes. This dressing is then held in place with an adhesive fabric tape, currently Mefix tape, which is typically applied by the surgical scrub tech.

If allocated to coverage with glue, no dressing is placed. After closure of the incision with suture or staples, the incision is patted dry under sterile conditions. The incision is then covered longitudinally by a member of the surgical team with a thick layer of skin glue dispensed from 1 tube of surgical skin glue (2-octyl cyanoacrylate, currently using brand: Derma+Flex QS). The glue is then allowed to dry before the sterile surgical drapes are removed.

Staples placed for incision closure are routinely removed on the day of discharge. Sutures placed for skin closure are absorbable and are therefore not removed.

Study Type

Interventional

Phase

  • Not Applicable

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Pregnant women admitted to Labor and Delivery for scheduled cesarean section, for labor, or for induction of labor
  • Age >/= 18 years
  • All gestational ages
  • All numbers of gestations
  • All fetal presentations
  • All maternal and fetal medical or surgical comorbidities are included except as listed in the exclusion criteria

Exclusion Criteria:

  • Patient is under 18 years of age.
  • Intrauterine fetal death, excluded simply for social reasons concerning consenting the patient for the study during upsetting circumstances.
  • Patient is NOT fluent in English, Spanish, or Portuguese.
  • Urgent or emergent cesarean delivery for fetal distress that develops before the patient is approached for consent
  • Patient incompetent to provide independent informed consent.
  • Patient has a known allergy to Glue, Tape, Cyanoacrylate, and/or Formaldehyde.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
NO_INTERVENTION: Control
This group would be receiving the standard of care. The subject would receive the standard dressing applied by a member of the surgical team in the standard fashion as follows: The closed incision will be covered first with a primary dressing consisting of a nonadherent, composite dressing (Telfa), which is covered with a secondary dressing consisting of an Army Battle Dressing (ABD), before removal of the sterile surgical drapes. This dressing is then held in place with an adhesive fabric tape, currently Mefix tape, which is typically applied by the surgical scrub tech.
EXPERIMENTAL: 2-octyl cyanoacrylate
This group would receive the experimental treatment. If allocated to coverage with glue, no dressing is placed. After closure of the incision with suture or staples, the incision is patted dry under sterile conditions. The incision is then covered longitudinally by a member of the surgical team with a thick layer of skin glue dispensed from 1 tube of surgical skin glue (2-octyl cyanoacrylate, currently using brand: Derma+Flex QS). The glue is then allowed to dry before the sterile surgical drapes are removed.
Device: 2-octyl cyanoacrylate
If the subject is allocated to the experimental group, they would receive 2-octyl cyanoacrylate in place of a primary dressing consisting of their non-adherent composite dressing (Tefla) and a secondary dressing of Army Battle Dressing (ABD).
Other Names:
  • Derma+flex QS

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Any Significant complications
Time Frame: 30 Days following cesarean delivery.
the primary outcome of the study will be a composite outcome of any significant complications including wound separation, wound infection, symptomatic seroma or hematoma, or readmission for a wound complication within 30 days postoperatively. This data is gathered from the subject's medical record and from the Discharging Resident Questionnaire.
30 Days following cesarean delivery.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Minor Complications and/or Patient Dissatisfaction
Time Frame: 30 Days following cesarean delivery
Secondary outcomes will include problems with the periwound skin including blistering or skin tears, as well as pain or itching of the wound and periwound skin, narcotic use during the hospitalization, and overall patient satisfaction with the incision at the time of discharge. This data is gathered from the subject's medical record and the Patient Discharge Questionnaire, the Patient Follow-Up Questionnaire, and the Physician Follow-Up Questionnaire(if applicable).
30 Days following cesarean delivery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Danbury Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

January 1, 2015

Primary Completion (ACTUAL)

March 1, 2015

Study Completion (ACTUAL)

March 1, 2015

Study Registration Dates

First Submitted

December 18, 2014

First Submitted That Met QC Criteria

December 18, 2014

First Posted (ESTIMATE)

December 23, 2014

Study Record Updates

Last Update Posted (ESTIMATE)

March 10, 2015

Last Update Submitted That Met QC Criteria

March 9, 2015

Last Verified

March 1, 2015

More Information

Terms related to this study

Other Study ID Numbers

  • WCHN/IRB 13-56

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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