Abdominal Wall Closure Tim Brandys MD FRCSC

Avoid Evisceration

Predisposing Factors: Poor Technique Poor Suture Selection Closure Under Tension Wound Infection Patient Factors Type of Incision

Technique: Understanding anatomy

Anatomy Landmark for the Arcuate line is ant. Sup. Iliac spine

Anatomy

Anatomy Internal Oblique Aponeurosis splits above arcuate line to help form the ant. and post sheath. Below the arcuate line all aponeuroses move ant to the rectus and there is no post.sheath.

Technique Suture selection = Non absorbable,Long lasting Absorbable Suture spacing 1cm apart,1cm deep Running is best Suture length = 4x length of wound to avoid excess tension

Technique Do not close under tension, use mesh or don’t close at all

Type of Incision: Incidence Post op Ventral Hernia: Midline = 10.5% Transverse = 7.5% Paramedian = 2.5% UPPER MIDLINE MOST LIKELY

“Tricks of the Trade” SURGIFISH Kocher,Kocher

DEHISCIENCE Dx = Serous fluid leak Palpate fascia gap Rx = Usually immediate Debride prn Mesh Retention sutures Smead Jones Leave open

RETENTION SUTURES:

Smead Jones Closure

SCALPEL Holding the scalpel properly

Cutting DON’T SCIVE IT!

Today Scalpel Handling tech Drain Insertion Abdominal wall closure Retention sutures