Stylized cesarean section incision closed with sutures.

Cesarean Closure: Why Suture Remains the Gold Standard for Skin Incisions

Theo Raines in Health & Wellness December 2025 • 4 min read.

"Despite advancements in surgical techniques, absorbable suture continues to lead in cesarean skin closure due to its superior outcomes and patient satisfaction."

Cesarean delivery (CD), one of the most common surgical procedures performed worldwide, has seen numerous advancements in techniques aimed at improving outcomes and patient experience. Among these advancements, the method of skin closure remains a critical aspect of the procedure. With over 1,000 randomized controlled trials (RCTs) dedicated to the technical nuances of cesarean delivery, the choice between sutures, staples, glue, and other methods has been a topic of extensive research and debate.

In a recent mini-commentary, experts weighed in on a 2018 randomized clinical trial that compared absorbable subcuticular staples versus suture for cesarean closure. This commentary sheds light on why suture continues to be regarded as the gold standard for skin incision closure in cesarean deliveries, despite the introduction of newer methods.

This article delves into the evidence supporting the use of absorbable sutures for skin closure in cesarean sections. We will explore the comparative studies, the advantages of suture over other methods such as staples and glue, and the implications for patient outcomes and satisfaction. By examining the current research and expert opinions, we aim to provide a comprehensive understanding of why suture remains the preferred choice in modern obstetrical practice.

Why Suture Holds Its Ground: Evidence from Research

Stylized cesarean section incision closed with sutures.

Numerous studies have compared absorbable suture to nonabsorbable metal staples for skin closure following cesarean delivery. A meta-analysis of 12 RCTs, involving 3,112 women, demonstrated that suture closure is associated with fewer wound complications, particularly wound separation. This finding underscores the reliability and effectiveness of suture in promoting better healing outcomes.

Beyond the reduced risk of wound complications, suture closure offers additional benefits that contribute to its status as the gold standard. These include improved cosmesis and increased patient satisfaction. Studies have shown that women who undergo suture closure report higher levels of satisfaction with the aesthetic outcome of their scars compared to those who receive metal staple closure.

Reduced Wound Complications: Meta-analyses show lower rates of wound separation with suture closure.
Improved Cosmesis: Suture closure leads to more aesthetically pleasing scar appearance.
Increased Patient Satisfaction: Women report higher satisfaction levels with suture closure outcomes.
Gold Standard Recommendation: Current guidelines favor absorbable suture for skin closure due to robust evidence.

While glue (Dermabond) has been explored as an alternative to suture, the evidence remains less compelling. One RCT (n=107) found no significant difference in outcomes between glue and suture, while another (n=82) reported less pain in the glue arm during the first two weeks post-cesarean. However, these findings have not been consistently replicated, and the overall data supporting glue as a superior option is limited.

The Future of Cesarean Skin Closure

While absorbable suture remains the gold standard for skin closure in cesarean deliveries, ongoing research continues to explore potential alternatives. A recent study in BJOG compared absorbable staples to suture, finding similar incidences of wound complications and patient satisfaction. However, absorbable staples were associated with longer placement times and higher costs, suggesting that further research is needed before they can be considered a superior option. As technology advances and new materials become available, the future of cesarean skin closure may see further refinements. However, for the time being, absorbable suture remains the most reliable and evidence-based choice for optimizing patient outcomes and satisfaction.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

Why is absorbable suture considered the gold standard for skin closure in cesarean deliveries?

Absorbable suture is considered the gold standard for skin closure in cesarean deliveries due to its superior outcomes and patient satisfaction, as evidenced by numerous studies and meta-analyses. These studies, including a meta-analysis of 12 RCTs, have consistently demonstrated that suture closure leads to fewer wound complications, particularly wound separation, compared to methods like staples. Furthermore, suture closure results in improved cosmesis, meaning a more aesthetically pleasing scar appearance, and higher patient satisfaction levels. Current guidelines favor absorbable suture for skin closure because of this robust evidence base.

What are the key advantages of using absorbable suture over metal staples for cesarean skin closure?

The primary advantages of absorbable suture over metal staples for cesarean skin closure include a reduced risk of wound complications, better cosmetic outcomes, and increased patient satisfaction. Meta-analyses show lower rates of wound separation with suture closure, contributing to better healing. Suture closure also leads to more aesthetically pleasing scar appearance, which is a significant factor in patient satisfaction. Metal staples, while offering a quick closure method, often result in less desirable cosmetic outcomes and, in some studies, higher rates of complications compared to suture. These benefits of suture are well-documented through numerous randomized controlled trials (RCTs), making it the preferred method.

How does the use of glue (Dermabond) compare to absorbable suture in terms of outcomes after cesarean delivery?

The evidence for using glue (Dermabond) as an alternative to absorbable suture is less compelling. While one RCT (n=107) found no significant difference in outcomes between glue and suture, and another (n=82) reported less pain in the glue arm during the first two weeks post-cesarean, these findings have not been consistently replicated across different studies. The overall data supporting glue as a superior option is limited, and it does not provide the same level of evidence-based benefits as suture, especially regarding reduced wound complications and improved cosmesis. Thus, glue has not yet gained widespread acceptance as the preferred method for cesarean skin closure.

What are the potential future trends and alternatives to absorbable suture for cesarean skin closure?

While absorbable suture remains the gold standard, ongoing research explores potential alternatives. Absorbable staples have been studied, with a recent study in BJOG finding similar incidences of wound complications and patient satisfaction compared to suture. However, absorbable staples were associated with longer placement times and higher costs, indicating the need for more research before they can be considered superior. As technology advances, the future of cesarean skin closure may see further refinements with new materials and techniques, but for now, suture remains the most reliable and evidence-based choice for optimizing patient outcomes and satisfaction.

Why is patient satisfaction an important factor in choosing a skin closure method for cesarean delivery?

Patient satisfaction is a crucial factor in choosing a skin closure method for cesarean delivery because it reflects the overall experience and well-being of the patient, beyond just the clinical outcomes. Methods like absorbable suture not only lead to reduced wound complications but also improve cosmesis, resulting in more aesthetically pleasing scars. Studies show that women who undergo suture closure report higher levels of satisfaction with the aesthetic outcome of their scars compared to those who receive metal staples. This improved aesthetic outcome contributes to a better emotional and psychological recovery, enhancing the overall patient experience. Therefore, choosing a method that prioritizes both clinical effectiveness and patient satisfaction is essential in modern obstetrical practice.