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Another comment on surgical closure techniques.From: K Dew (kdew@bellsouth.net)Tue Aug 8 19:46:57 2000
Just another $.02. One of the attendings I worked with as a resident closed in the following manner: Always used vertical midline incisions. 3-0 chromic on the peritoneum, close and tight 0-chromic figure of eights on the fascia, close and tight (about 12 in an 8 inch incision) at least 10 interrupted 2-0 chromics in the sub-cutaneous fat, no matter how thin or thick the patient. I counted 24 one time in a greatly obese woman he did use staples. that was his only "modern" closure technique. I had the opportunity to do Many Many repeat c-sections or hysterectomies on patients on whom he had operated before. No big difference that I could see between his patients and those who were closed in the more "modern" ways. I never saw a patient of his with a postoperative hernia or wound dehiscence. No, he didn't take his problems elsewhere, he only admitted to our hospital. I appreciate the comment on my choice of closing. I think we must tailor the closure at times. I don't routinely close the peritoneum, but every now and then I'll place a few stitches through because I'm tired of fighting the bowel as it pokes through. I don't always close sub-q but I am a believer that, on a vertical incision, big deep bites help keep tension off. It only makes sense from a purely "physics" standpoint.
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