Re: MacLean AB, MacLean SB. 2008. Suture materials and subsequent wound strength. Journal of Obstetrics and Gynaecology 28:561–562

Dear Sir,

I read with interest the editorial about suture material for closing the uterine wound during caesarean section (Maclean and Maclean 2008) following the publication in the Journal of Obstetrics and Gynaecology of two case reports about spontaneous rupture of the scar during the second trimester, where the placenta was not implanted over the scar area. The editorial suggests that closing the uterine wound using chromic catgut, which was used decades ago, might lead to stronger scar, and thus less incidence of rupture, than polyglactin. It would be interesting to actually compare the incidence of uterine scar rupture over different eras. Perhaps suturing the uterine wall during myomectomy, when oestrogen and progesterone levels are much lower than at the time of caesarean delivery, might be another area to look at. Recent literature published in this journal shows that myomectomy, especially through open laparotomy, need not necessarily lead to offering an elective section as the risk of scar rupture is low (Kelly et al. 2008). No information was given in this retrospective series about the nature of suture used for closing the uterine wall and whether the uterine cavity was opened or not. The author of this letter encountered a case of successful vaginal delivery following open myomectomy where the cavity was opened during removal of a posterior uterine wall fibroid that encroached on the cervix. The uterine wall was closed using Vicryl and the peritoneum was closed using Prolene.

The authors are right to highlight the need to research wound strength following different suture material, including chromic catgut and polyglactin (Vicryl), and looking at the style of wound closure. The author of this letter has long experience using two layers of polyglactin (Vicryl) suture in a continuous knotted fashion, taking a knot after taking a bite on the lower and upper\rquote edges of the uterine incision, and believes this offers the benefits of both continuous and interrupted sutures, although this\rquote has not been studied. It is hoped that the CAESAR study, due\rquote for publication this year, will add some light on closure techniques.