Objective: The aim of this study was to determine the effect of the depth of subcutaneous tissue at the operative site and the closure of subcutaneous tissue on abdominal wound disruption after cesarean delivery. Methods: 164 women divided into two groups: 70 with subcutaneous tissue thickness of at least 2 cm and 94 with subcutaneous tissue thickness more than 2 cm. These groups were randomized to closure of the subcutaneous fat tissue or no closure with cesarean delivery. Results: In the 68 women with subcutaneous tissue thickness of at least 2 cm who completed the study, there was no difference between closure and no closure subgroups in terms of incidence of wound disruption. In 91 women with subcutaneous tissue thickness more than 2 cm who completed the study, the incidence of wound disruption was significantly higher in the no closure subgroup. In the no closure subgroup of 91 women with subcutaneous fat thickness more than 2 cm, the incidence of wound disruption was significantly higher than that of the 68 women with subcutaneous tissue thickness at least 2 cm. Conclusions: Subcutaneous tissue approximation with absorbable suture at closure of the abdominal incision during cesarean delivery appears to reduce the rate of postoperative wound disruption in patients with more than 2 cm of subcutaneous tissue. (C) 1997 International Federation of Gynecology and Obstetrics.