Lankan-born physician’s study breaks new ground in States


A widely-recognised study by Sri-Lankan born Dr. A. Dhanya Mackeen, the Director of Research at the Division of Maternal Fetal Medicine, in the Geisinger Health System in the USA, is featured in the current issue of US Obstetrics and Gynecology.
The study, which has been widely reported in the US media, including the New York Times and Cable News Network (CNN), concludes that suture closure of the C-section skin incision is associated with less wound complications than staple closure. Despite the ever increasing C-section rate, the optimal way to close the C-section skin incision remained unanswered – until now, according to Dr Mackeen, MD, MPH and her colleagues.

Dr. Mackeen, led a multicentre, randomised clinical trial, the largest study of its kind, to evaluate which closure method was superior – suture or staples. Seven hundred and forty six women undergoing C-section at three US hospitals were randomised between 2010 and 2012 and followed for postoperative wound complications including wound infection, separation, collection of fluid and readmission for wound complications. The study showed that women whose skin incisions were closed with suture had a 57 percent lower rate of wound complications than women whose incisions were closed with staples (4.9% versus 10.6%, respectively). Also, women whose incisions were closed with suture were 80% less likely to have a wound separation of greater than or equal to 1 cm.

Though smaller studies had been published previously, the current one included more patients, predefined the length of wound separation that would be considered significant, waited until at least day four to remove staples, gave preoperative antibiotics to 100% of patients, and only included women with horizontal skin incisions.

Their study population was diverse in terms of race, insurance source and marital status. Additionally, the majority of women (63%) included in Dr Mackeen’s study had a body mass index greater than or equal to 30 kg/m2 (defined as obese) which suggests that their sample is representative of the obesity prevalent in much of the developed world.

The appropriate closure of C-section skin incisions has been debated in the obstetrics community; in a prior study, Dr Mackeen et al. found that obstetricians use staples and suture with similar frequency. “Although closure with staples is faster than closure with suture, in cases in which speed is not a serious concern, this study supports closure of the transverse cesarean skin incision with suture to decrease cesarean wound complications,” Dr. Mackeen stated.

“This study provides evidence that women undergoing C-sections benefit from having suture instead of staples to close their skin incisions,” said Dr. Mackeen, the daughter of Rifky and (late) Siromani Mackeen who emmigrated to the US in 1986. Her paternal grand uncle was Dr C.M.M. Zubair, the first Ceylon Moor to graduate as a Medical Doctor from the University of Edinburgh, Scotland. He succumbed to meningitis prior to returning to Sri Lanka.