What size Vicryl (polyglactin 910) suture is preferred for a cesarean delivery?

Vicryl Suture Size for Cesarean Delivery

For cesarean delivery, use 4-0 Vicryl (polyglactin 910) for subcuticular skin closure and standard weight Vicryl (typically 0 or 2-0) for uterine closure, as these sizes are supported by clinical evidence and guideline recommendations.

Skin Closure

Recommended Size and Technique

• 4-0 Vicryl is the standard size for subcuticular skin closure at cesarean delivery, demonstrating comparable safety and efficacy to other absorbable sutures 1
• Subcuticular suture closure is preferred over staples due to reduced wound complications 2
• A randomized trial directly comparing 4-0 Vicryl to 3-0 poliglecaprone-25 (Monocryl) found similar composite wound complication rates (16% vs 10%, p=0.293), though 3-0 Monocryl showed slightly lower pain scores 3

Clinical Performance

• 4-0 Vicryl demonstrates surgical site infection rates of 5.1-6.1%, with no significant difference compared to 4-0 Monocryl (adjusted OR 1.23,95% CI 0.60-2.49) 1
• Wound complication rates remain comparable regardless of patient factors including obesity, diabetes, or whether the cesarean was scheduled or emergent 1
• Consider triclosan-coated Vicryl (Vicryl Plus) when available, as it reduces surgical site infections (OR 0.62,95% CI 0.44-0.88) 4

Uterine Closure

Suture Material Selection

• Guidelines recommend delayed absorbable sutures including polyglactin 910 (Vicryl), poliglecaprone-25 (Monocryl), or chromic catgut for two-layer uterine closure, with no strong evidence favoring one material over another 5
• Standard weight Vicryl (typically 0 or 2-0) is commonly used for uterine closure, though specific size recommendations are not explicitly stated in guidelines 5, 6

Closure Technique

• Two-layer closure may be associated with lower uterine rupture rates in subsequent pregnancies, though evidence quality is low 2, 5
• Blunt expansion of the transverse uterine hysterotomy is recommended to reduce blood loss 2
• Continuous suturing techniques are preferred over interrupted sutures for more even tension distribution 6

Additional Surgical Considerations

Subcutaneous Tissue

• When subcutaneous tissue depth is ≥2 cm, reapproximation should be performed to reduce wound complications 2
• Standard weight Vicryl is appropriate for subcutaneous closure, with clinical equivalence demonstrated between different polyglactin 910 brands 7

What to Avoid

• Do not close the peritoneum, as this does not improve outcomes and increases operative time 2, 5
• Avoid overly tight sutures that can strangulate tissue and impair healing 4, 6