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The Effects of Changing Surgical Blades After Skin Cutting During Cesarean Section on the Risk of Postoperative Infectious Morbidity: A Single-Blinded Randomized Trial at a Tertiary Hospital

Charlene M. Flores, MD; Sybil Lizanne R. Bravo, MD, FPOGS
Department of Obstetrics and Gynecology, Philippine General Hospital

Background. Various operative procedures and techniques have been made in attempts to diminish the incidence of postoperative wound infection. The use of two surgical knives was found to have no correlation to wound infection in several orthopedic-related surgeries. No studies, however, could be found on the effects of using such technique in cesarean section. The purpose of this study is to determine whether the use of different surgical blades for skin cutting and deep tissue incision decrease the incidence of post-cesarean infectious morbidity.

Methods. A total of 190 obstetric patients admitted for scheduled or nonscheduled cesarean section were randomly assigned to two groups by sealed number envelopes. The first group was composed of patients who used only one blade for skin and deep tissue incision. The second group used separate blades. Patients from both groups were assessed days 0 to 2 post-cesarean and 2-4 weeks after (on follow-up). The temperature pattern post-operative was monitored as well as presence of wound discharge, foul-smelling vaginal discharge, persistent abdominal pain, and persistent fever that may indicate surgical site infection, postpartum endometritis, and pelvic abscess. Statistical analysis was performed using the Fisher’s Exact test.

Results. Nineteen (11.3%) of 168 patients had superficial surgical site infection, 11 (13.3%) from the single blade group, compared with 8 (9.4%) from the double blade group. The difference between the two groups was not statistically significant (p=0.29). None of the patients developed deep incisional or organ space surgical site infection, endometritis, or pelvic abscess post-cesarean. There was also no significant difference for the two groups in temperature pattern and presence of wound discharge or wound dehiscence.

Conclusion. The use of different surgical blades for skin cutting and deep tissue incision does not show to decrease post-cesarean infectious morbidity. It is unnecessary to use two knives for surgical incisions in cesarean section.

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