1. Abdominal Wall Closure
Tim Brandys MD FRCSC

2. Avoid Evisceration

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

4. Technique:
Understanding anatomy

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

6. Anatomy

7. 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.

8. 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

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

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

11. “Tricks of the Trade”
SURGIFISH
Kocher,Kocher

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

13. RETENTION SUTURES:

14. Smead Jones Closure

15. SCALPEL
Holding the scalpel properly

16. Cutting
DON’T SCIVE IT!

17. Today Scalpel Handling tech Drain Insertion Abdominal wall closure
Retention sutures