Skin Adhesive Versus Subcuticular Suture for Perineal Skin Repair After Episiotomy: A Randomized Controlled Trial

During the puerperium, surgical repair of perineal lesions is frequently associated with pain and discomfort interfering with the normal daily activities. The use of skin adhesive glue (octyl-2-cyanoacrilate) is a relatively new method for repair of cutaneous lesions that appears to be a safe and rapid alternative to a continuous subcuticular suture of the perineal skin, a traditional method commonly used in many countries. Preliminary studies suggested several advantages of skin adhesive over other types of suture. However, these studies had small sample sizes, lacked a control group, were not randomized or did not use subcuticular suture for comparison. This randomized controlled trial compared the skin adhesive glue with continuous subcuticular suture for perineal skin repair after episiotomy. A total of 100 women having mediolateral episiotomy at vaginal delivery were randomized to receive either skin adhesive (n = 53) or subcuticular suture (n = 47) for closure of perineal skin. The primary study outcome was self-assessed perineal pain during the first 30 days after delivery. Secondary outcomes included technical difficulties and duration of the perineal repair procedure, wound complications at 42 to 68 hours or in the first 30 days after repair, and the reinitiation of sexual activity by 30 days postpartum. To evaluate these outcome measures, patients were asked to complete a daily questionnaire. Forty-nine (92%) of the women in the skin adhesive group and 37 (79%) of those in the subcuticular suture group returned the questionnaire. No significant differences between the 2 groups were reported in the incidence of pain, technical difficulties, or failure of the perineal repair procedure. In addition, no significant differences were observed in the number of wound complications observed at 42 to 68 hours, in reinitiation of sexual activity by the 30th day postpartum, self-reported measures of pain at 7 and 30 days, or the need to be evaluated at a healthcare facility within 30 days. The only significant difference between the 2 study groups was a 4 minute shorter duration of wound repair with the skin adhesive. Compared to continuous subcuticular suture repair of episiotomy, the only advantage of skin adhesive devices appears to be a slightly shorter duration of surgical repair, which is of questionable clinical significance. The investigators conclude that these findings provide no evidence to support the use of skin adhesive devices in episiotomy repair.