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Abdominal Wall Closure

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Presentation on theme: "Abdominal Wall Closure"— Presentation transcript:

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


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

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