Symbolic illustration of a Cesarean suture line healing and protecting new life.

Suture Showdown: Why the Traditional Method Still Reigns Supreme in Cesarean Closures

Jordan Keane in Health & Wellness November 2025 • 4 min read.

"Despite advancements, absorbable suture remains the gold standard for skin closure in Cesarean deliveries. Here's why, and what the latest research reveals."

For decades, Cesarean deliveries (CD) have been a common surgical procedure, with over 1,000 randomized controlled trials (RCTs) dedicated to refining its technical aspects. Among these, the method of skin closure stands out as a crucial element influencing both cosmetic outcomes and patient recovery. The question isn't just about closing the incision, but about achieving the best possible results for the new mother.

Numerous options exist for skin closure during a CD, including sutures, staples, and surgical glue. Each method presents its own set of advantages and disadvantages, leading to ongoing debates within the medical community about which technique provides the optimal balance of efficacy, safety, and patient satisfaction. This article delves into the evidence supporting the continued use of sutures as the gold standard, while also examining the potential of newer alternatives.

We will explore the findings of recent research, including a mini-commentary on a 2018 randomized controlled trial, to understand why absorbable sutures have maintained their position as the preferred choice for many surgeons. Furthermore, we will discuss the comparative data on sutures versus staples and glue, offering a comprehensive overview of the current landscape in Cesarean skin closure techniques.

Suture's Enduring Reign: Why It Remains the Gold Standard

Symbolic illustration of a Cesarean suture line healing and protecting new life.

Sutures, particularly absorbable sutures, have consistently demonstrated superiority in terms of minimizing wound complications. A meta-analysis encompassing 3,112 women across 12 RCTs revealed that suture closure is associated with fewer instances of wound separation compared to nonabsorbable metal staples. This is a crucial factor, as wound separation can lead to increased risk of infection, prolonged healing times, and greater discomfort for the patient.

Beyond the reduced risk of complications, sutures also offer distinct advantages in terms of cosmetic outcomes and patient satisfaction. Studies have indicated that patients report improved cosmesis following suture closure, contributing to a more positive overall experience. This subjective element underscores the importance of considering patient perspectives when evaluating different closure methods.

Reduced Wound Separation: Meta-analyses show sutures lead to fewer wound complications.
Improved Cosmesis: Patients report better cosmetic outcomes with suture closure.
Higher Satisfaction: Enhanced cosmetic results contribute to greater patient satisfaction.

While sutures have long been considered the standard, other methods like staples and glue have emerged as potential alternatives. Staples, often made of metal, offer the advantage of quick application. However, they can be associated with a higher risk of wound complications and may not provide the same level of cosmetic satisfaction as sutures. Surgical glue, on the other hand, offers a non-invasive option, but its effectiveness and long-term outcomes are still under investigation.

The Future of Cesarean Skin Closure: Innovation and Individualized Care

While absorbable sutures currently hold the position of gold standard, ongoing research continues to explore innovative techniques and materials for Cesarean skin closure. The goal is to further minimize complications, optimize cosmetic outcomes, and enhance the overall patient experience. As technology advances, we may see the emergence of new and improved methods that challenge the traditional approach. Ultimately, the choice of closure technique should be made on a case-by-case basis, considering individual patient factors, surgeon expertise, and the latest evidence-based guidelines. Collaboration between healthcare providers and informed patients is essential to ensure the best possible outcomes for every Cesarean delivery.

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.

This article is based on research published under:

DOI-LINK: 10.1111/1471-0528.15552, Alternate LINK

Title: Suture Is Still The Gold Standard For Closure Of The Skin Incision At Caesarean Delivery

Subject: Obstetrics and Gynecology

Journal: BJOG: An International Journal of Obstetrics & Gynaecology

Publisher: Wiley

Authors: V Berghella, Jk Baxter, Ad Mackeen

Published: 2018-12-25

Everything You Need To Know

Why are absorbable sutures considered the gold standard for skin closure in Cesarean deliveries?

Absorbable sutures are favored due to their proven track record in minimizing wound complications. Meta-analyses, including studies encompassing thousands of women, reveal that suture closure leads to fewer instances of wound separation compared to nonabsorbable metal staples. This is critical for reducing infection risks, speeding up healing, and improving patient comfort. Additionally, patients tend to report better cosmetic outcomes and higher satisfaction with suture closures, contributing to a more positive overall experience.

What advantages do absorbable sutures offer over staples and surgical glue in Cesarean skin closures?

Compared to staples, absorbable sutures are associated with a lower risk of wound separation and improved cosmetic outcomes. While staples offer quick application, they can lead to more complications and less patient satisfaction. Surgical glue, a non-invasive option, is still under investigation, and its long-term effectiveness isn't as well-established as absorbable sutures. Sutures provide a balance of efficacy, safety, and patient satisfaction supported by substantial research, as highlighted by numerous randomized controlled trials.

How do patient satisfaction and cosmetic outcomes factor into the choice between sutures, staples, and glue for Cesarean skin closure?

Patient satisfaction and cosmetic outcomes are significant factors. Studies indicate that patients generally report improved cosmesis following suture closure compared to staples. This subjective element is vital because a more aesthetically pleasing result can lead to a more positive overall experience for the new mother. While objective clinical outcomes are essential, considering patient perspectives on cosmetic results and comfort is crucial in determining the optimal closure method.

What does existing research say about the effectiveness of sutures versus staples for skin closure after Cesarean sections?

Research, including meta-analyses of randomized controlled trials, indicates that suture closure is associated with fewer instances of wound separation compared to nonabsorbable metal staples. Wound separation increases the risk of infection, prolongs healing, and causes discomfort. The 2018 randomized controlled trial mini-commentary supports the use of absorbable sutures. Staples, while quicker to apply, do not provide the same level of protection against these complications.

Given that absorbable sutures are currently favored, what innovations might change Cesarean skin closure practices in the future?

While absorbable sutures are the current gold standard, ongoing research is exploring new techniques and materials to further enhance Cesarean skin closure. Future innovations aim to minimize complications, optimize cosmetic results, and improve the overall patient experience. As technology evolves, we may see the emergence of improved methods that could challenge the traditional approach of suture closure. This includes advancements in surgical glue formulations, novel suture materials, or even robotic-assisted closure techniques. However, adoption will depend on rigorous evidence demonstrating superiority over absorbable sutures.