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