RP: Staples or Stitches?

planeNsimple · April 2012

So I had hear horror stories with Staples so I opted for Stitches during my last csection. Everything seemed fine and it wasn't a big deal. I asked my new OB about her opinion and she said she liked the staples better because they itched less. I had a TON of itching with my c/s last time. What are your thoughts? Any experience you care to share? Any reason you chose one over the other?

babymomma623 · April 2012

Neither. I had the outside glue last time and I liked it! It did take a while for it all the come off so it kind of was weird when it peeled, but I don't remember terrible itching at all. Worth seeing if they do that.

planeNsimple · April 2012

I forgot about that! My last OB didn't do that so I just did stitches. I will have to ask this ob. Thanks for reminding me!

NicholeeK · April 2012

I had staples. I keloid scar and the doctor at the time said it can help lessen that... not sure if that is actually true or not since one of my nurse friends said she heard it doesn't do that and they just tell people that, lol. Either way, I still keloided. I did not itch at all. A couple of them were tender and they felt like they were pulling, but once they were out, I was fine. Oddly enough, the places where the ones that bugged me are the two spots on my scar that are not raised.

planeNsimple · April 2012

NicholeeK:
I had staples. I keloid scar and the doctor at the time said it can help lessen that... not sure if that is actually true or not since one of my nurse friends said she heard it doesn't do that and they just tell people that, lol. Either way, I still keloided. I did not itch at all. A couple of them were tender and they felt like they were pulling, but once they were out, I was fine. Oddly enough, the places where the ones that bugged me are the two spots on my scar that are not raised.

What is Keloided? Sorry if that is a dumb question, I just have never heard of it. Thanks for sharing your experience!

selockar · April 2012

Just a word of caution. Some OB's will say to do staples just out of convenience for them. They are way faster to do. I opted for stitches because my DH is a surgeon and recommended stitches. He also knew I would not like having staples taken out before I left the hospital. He was right I didn't want anyone touching me and could not imagine if someone had tried to pull out staples. I don't think all ob's take them out before you are discharged. You might want to check on that.

planeNsimple · April 2012

sarahe101:
Just a word of caution. Some OB's will say to do staples just out of convenience for them. They are way faster to do. I opted for stitches because my DH is a surgeon and recommended stitches. He also knew I would not like having staples taken out before I left the hospital. He was right I didn't want anyone touching me and could not imagine if someone had tried to pull out staples. I don't think all ob's take them out before you are discharged. You might want to check on that.

That is what I had hear too and a reason I chose stitches with the last one. I did ask her if they come out before I leave the hospital and she said yes. So that is good at least. I asked her if they hurt coming out (I can't imagine they wouldn't) and she said it feel just like a little pinch. (She personally has had 3 c/s, one with stitches and 2 with staples, so she was talking from her experience)

NicholeeK · April 2012

planeNsimple:
NicholeeK:
I had staples. I keloid scar and the doctor at the time said it can help lessen that... not sure if that is actually true or not since one of my nurse friends said she heard it doesn't do that and they just tell people that, lol. Either way, I still keloided. I did not itch at all. A couple of them were tender and they felt like they were pulling, but once they were out, I was fine. Oddly enough, the places where the ones that bugged me are the two spots on my scar that are not raised.

What is Keloided? Sorry if that is a dumb question, I just have never heard of it. Thanks for sharing your experience!

It's a raised scar from too much scar tissue building up (or something to that effect). My scar looks like an earthworm laying on top of my skin.

Oh and I only had my staples for a couple of days and then they took them out and put steri-strips on across it (those little tape strip things) and I had those until they fell off in the shower (maybe a week at most?).

cs1007 · April 2012

Hmmm..I was never given a choice, just given staples..I had no problems healing and I don't recall itching being that bad.

jknigh8 · April 2012

I opted for stitches (I wasn't offered, I asked him beforehand for them) because I knew two women who had problems with staples (infection, incision opening back up)... I think the staples would be more comfortable, they wouldn't pull as tight when you move, cough, laugh ect. But I never itched with my stitches and never worried about my incision. I had such a small, clean scar, no infection or problems that I am definitely doing stitches again this time.

Also, like pp said, I cant imagine having to have staples removed so soon... I barely wanted the shower water to hit my incision area

BelleWithABlade · April 2012

It really depends on what you mean by stitches. If you mean dissolvable sutures, they scar less. Anything you need to remove will have marks around the incision and make the incision look worse. All foreign bodies cause itching and there isn't any evidence staples cause less then sutures (of any type). Itching is a normal part of the healing process and indicate reactivation of small nerves damaged in the area.

There is nothing magical about skin glue. It doesn't do anything other then making the incision waterproof immediately. If your OB is not letting you shower for a few days there is no reason to use glue and it actually drives many patients nuts. Some people have skin reactions to it and others just hate the peeling. It does not make for better scars.

Staples are much, much faster but IMPO the scars look worse. The key to getting a good scar out of a c-section is to have the OB close in three layers. They should close scarpas layer with a 3-0 absorbable, interrupted dermals with 4-0 or 3-0 absorbables (this is the strength layer), and a running subcuticular with a 4-0 absorbable. I revise TONS of c-section scars because it is not routine for them to close in the way a surgeon does. As for dressings (which is what the glue is considered because it really is not sufficient by itself for an abdominal closure) it doesn't matter. Steri strips, glue, tape, xeroform, etc are equivalent.

Another thing to mention is that if you can remember, request the fascia be closed with PDS, not vicryl. OB's love vicryl eventhough there is strong evidence in the general surgery literature that the closure is inferior and leads to more hernias. Women have 2-3 times the hernia rate after abdominal surgery, likely because a lot of abdominal surgery on women is performed by OB's.

Oh and probably should have mentioned, I'm a surgeon

BelleWithABlade · April 2012

planeNsimple:
NicholeeK:
I had staples. I keloid scar and the doctor at the time said it can help lessen that... not sure if that is actually true or not since one of my nurse friends said she heard it doesn't do that and they just tell people that, lol. Either way, I still keloided. I did not itch at all. A couple of them were tender and they felt like they were pulling, but once they were out, I was fine. Oddly enough, the places where the ones that bugged me are the two spots on my scar that are not raised.

What is Keloided? Sorry if that is a dumb question, I just have never heard of it. Thanks for sharing your experience!

a keloid is a benign tumor of scar tissue. It is a scar that looks like it is trying to escape the confines of the wound (like a ball hanging off someone's ear where they had a piercing). It is exceedingly rare to get a keloid on an abdominal incision. Most people who believe they have a keloid actually have what we call a hypertrophic scar. This is just a big thick, frequently unsightly scar that looks lika a big, hard worm under your skin. They are genetic and the type of closure you have doesn't cause a keloid or hypertrophic scar. Staples ABSOLUTELY do not prevent keloids or hypertrophic scars. If I think a patient has a higher likelyhood of having one due to history or ethnic background, I will start them on silicone sheeting as soon as the wound heals(studies show 12 weeks is sufficient) and inject it with steroid if it starts to act up. Unfortunately probably about 70-80% of your scaring is from genetics so thank your mom, don't blame me!

planeNsimple · April 2012

BelleWithABlade:
It really depends on what you mean by stitches. If you mean dissolvable sutures, they scar less. Anything you need to remove will have marks around the incision and make the incision look worse. All foreign bodies cause itching and there isn't any evidence staples cause less then sutures (of any type). Itching is a normal part of the healing process and indicate reactivation of small nerves damaged in the area.

There is nothing magical about skin glue. It doesn't do anything other then making the incision waterproof immediately. If your OB is not letting you shower for a few days there is no reason to use glue and it actually drives many patients nuts. Some people have skin reactions to it and others just hate the peeling. It does not make for better scars.

Staples are much, much faster but IMPO the scars look worse. The key to getting a good scar out of a c-section is to have the OB close in three layers. They should close scarpas layer with a 3-0 absorbable, interrupted dermals with 4-0 or 3-0 absorbables (this is the strength layer), and a running subcuticular with a 4-0 absorbable. I revise TONS of c-section scars because it is not routine for them to close in the way a surgeon does. As for dressings (which is what the glue is considered because it really is not sufficient by itself for an abdominal closure) it doesn't matter. Steri strips, glue, tape, xeroform, etc are equivalent.

Another thing to mention is that if you can remember, request the fascia be closed with PDS, not vicryl. OB's love vicryl eventhough there is strong evidence in the general surgery literature that the closure is inferior and leads to more hernias. Women have 2-3 times the hernia rate after abdominal surgery, likely because a lot of abdominal surgery on women is performed by OB's.
Oh and probably should have mentioned, I'm a surgeon

Wow you are a wealth of knowledge! Thank you so much for your input and taking the time to respond! I was referring to the desolvable stitches. I could be wrong, and please correct me if I am, but it sounds like you think those are the best options? Along with closing in three layers and PDS (not sure what this is) that is.

BelleWithABlade · April 2012

Yes that is what I would recommend and it's actually the only thing in my birth plan lol.

My C-section closure:

Uterus: whatever the OB wants

Rectus Fascia: a running 0 or #1 PDS (or maxon if the hospital has covidien sutures)

Scarpas Layer: please close in a separate layer with a running 3-0 Monocryl (or Biosyn if the hospital has covidien sutures)

Skin: please close in two layers, 4-0 Monocryl interrupted, burried dermals and a running 4-0 subcuticualar Monocryl.

I prefer skin glue so I can shower immediately (I know I don't have a reaction to it since I've used it before)

Just an FYI, if you want some info on post-op scar care:

1. Don't buy Mederma. It doesn't work and has been proven not to work in several prospective, randomized trials. In fact, it was shown to perform worse then doing nothing or putting plain old vasaline on the incision.

2. Vit E doesn't work and it has been shown not to work in studies. It causes skin reactions in 8-15% of people which can make scars worse. If you love it and know you don't react to it, rock on, but if you haven't used it before I wouldn't recommend it.

3. Once the incision heals (usually 3 weeks) and you want to do everything, start using scar gel (like Kelocote) or silicone sheeting (like Cicacare or Mepiform). It si the ONLY thing that has been shown in studies to actually make the scar look better. It is expensive, but worth it IMO. I personally like the mepiform better. You just cut a thin strip and place on the wound. It should be removed daily to shower and you can reapply the same piece for about 5-7 days before you need a new piece.

Hope that helps Plastic surgeons are obsessed with scars and incisions, I'm a loon I know.

planeNsimple · April 2012

BelleWithABlade:
Yes that is what I would recommend and it's actually the only thing in my birth plan lol.

My C-section closure:
Uterus: whatever the OB wants
Rectus Fascia: a running 0 or #1 PDS (or maxon if the hospital has covidien sutures)
Scarpas Layer: please close in a separate layer with a running 3-0 Monocryl (or Biosyn if the hospital has covidien sutures)
Skin: please close in two layers, 4-0 Monocryl interrupted, burried dermals and a running 4-0 subcuticualar Monocryl.
I prefer skin glue so I can shower immediately (I know I don't have a reaction to it since I've used it before)

Just an FYI, if you want some info on post-op scar care:
1. Don't buy Mederma. It doesn't work and has been proven not to work in several prospective, randomized trials. In fact, it was shown to perform worse then doing nothing or putting plain old vasaline on the incision.
2. Vit E doesn't work and it has been shown not to work in studies. It causes skin reactions in 8-15% of people which can make scars worse. If you love it and know you don't react to it, rock on, but if you haven't used it before I wouldn't recommend it.
3. Once the incision heals (usually 3 weeks) and you want to do everything, start using scar gel (like Kelocote) or silicone sheeting (like Cicacare or Mepiform). It si the ONLY thing that has been shown in studies to actually make the scar look better. It is expensive, but worth it IMO. I personally like the mepiform better. You just cut a thin strip and place on the wound. It should be removed daily to shower and you can reapply the same piece for about 5-7 days before you need a new piece.

Hope that helps Plastic surgeons are obsessed with scars and incisions, I'm a loon I know.

It more then helps!!! Thank you! I see you want the glue for closure for yourself. However you recommended the stitches? I'm just a little confused. But it could be because I'm tired . Just want to make sure I'm understanding. Thanks!

planeNsimple · April 2012

BelleWithABlade I have one more question for you. I have unfortunately a c/s flap from my last birth. Is there anything that cane be done to fix this? Just curious if you knew . Thanks

BelleWithABlade · April 2012

The glue doesn't replace the stitches, it is in addition to it. You can absolutely have c-section scars revised, I do it a lot. Some insurance plans cover it and others don't. If you have a hernia in addition to the scar, it's easy to get covered. Even if you pay out of pocket, it can be done under local in the office so it's not too much. It usually takes me like 30 minutes ;0) I just cut out the old incision and scar tissue, then re-close the wound the correct, anatomic way. If there is a hernia, that has to be fixed in the OR though.

planeNsimple · April 2012

That cleared up a lot! Thank you! So that would fix the c/s flap of skin!? That would be amazing! Is that recovery hard as the recovery from a c/s? Now if only I can get lipo and the flap fixed during the c/s! That would be AWESOME

jasrun80 · April 2012

I'd prefer staples because they come out completely. Stitches can leave residual stuff especially dissolvable etc & I honestly feel like the staples pull on skin less, stitches are just what tey say, they are stitching the skin in place, the staples hold the skin in place. They aren't like paper staples. Rats what I'd prefer if my doc agreed.

AmberMH08 · April 2012

i wasn't given an option... and I got staples they left them in almost 3weeks and the skin grew over them it was nooo fun getting them pulled out to say the least...and itched and burned.... if i have to have another CS this time i will want stiches i just hope for a VBAC this time i had horrible CS recovery..

tessatewks · April 2012

I'd opt for stitches. My staples still itched, and it was uncomfortable when they'd pinch me. Also, I'm not sure why people are saying you get them out before you leave teh hospital. I didn't get mine out until 7-10 days after the surgery. And they bled a bit and pinched a LOT when she took them out.

Daisy22 · April 2012

didn't have either one. I had dermabond (glue) for both my c/s and will request it again this time. My OB told me the reason I have to request it is they have had patients have a skin reaction to it so they don't automatically use it. My skin loves it and I have had more issues with stitches (I had a lapro that required stitches) so I really didnt' want them.

Stick Around · April 2012

I had staples and I didn't think they hurt at all coming out. They came out about 30 minutes before I left the hospital and they put steristrips on over the scar. My scar looks fine.

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