**1. Introduction**

Cesarean is a commonly performed obstetric surgery and in the recent times its number is constantly increasing. Standard technique for abdominal wall closure should be practiced considering the need to provide good support, prevent infections, sinus formation, and incision pain and scar dehiscence. There are multiple sutures and suturing techniques practiced worldwide for the closure of abdominal layers following cesarean section.

The history of sutures begins more than 2,000 years ago. Surgical and suture techniques evolved in the late 1800s with the development of sterilization procedures. It has been said that the scar is the "autograph of a surgeon". Every surgeon wants cosmetically acceptable scars along with optimal healing.

An ideal suture material should be cheap, sterile, non-electrolytic, nonallergenic, with adequate tensile strength, good handling characteristics, should not induce tissue reaction or cut through tissue.

A good suturing technique should ideally eliminate the dead space and minimize tension that causes wound separation. It involves correct wound placement with respect to relaxed tension lines. Consideration should focus on factors, such as systemic diseases and selection of ideal suture material that influence the outcome. The surgical technique used to close a given wound depends on the force and direction of tensions on the wound, the thickness of the tissues to be opposed and anatomic considerations.

### **1.1 Wound healing and inflammatory response**

The physiology of wound healing has 3 phases: inflammation, proliferation, and remodeling. Various factors like cytokines, cellular mediators are involved in the healing process.

Phase I: Inflammation (Onset of injury to day 4–6): The first phase of wound healing is characterized by hypoxic, ischemic environment with macrophages, neutrophils and platelet. Collagen, platelet, thrombin, fibronectin and fibrin with complements form a blood clot which has 3 major functions


Phase II: Proliferation (Days 4–14): It is marked by rapid construction of new tissue. Macrophages emit nitrous oxide thus dilating the vessels to accommodate influx of new cells. Granulation begins to form at this phase. Fibroblast which are recruited from the surrounding normal tissue starts synthesizing and depositing collagen.

Phase III: Maturation and remodeling (1 week- 1 year): The final stage of wound healing is characterized by evolution of matrix into ordered collagen complex. At one week, the wound has about 3 percent of its final strength, 30 percent of final strength at 3 weeks and ultimately achieves 80 percent of its final strength at 3 months and beyond. However wound will never regain the strength of an uninjured tissue.
