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Re: Single Layer vs Double Layer Uterine ClosureFrom: Efrain Ramirez (eramirezt@coqui.net)Mon Nov 10 03:58:30 2003
At Sun, 09 Nov 2003, Bernard Cristalli wrote: > >skin: bistouri >Horizontal incision to the fascia, open it horizontally on 1 inch in the >middle >I use a surgical towel to push the fat laterally (1/2 a second each). >the fascia is teared open with two fingers (I use fongers for the fat, scissors for fascia) > >the midline is opened with 2 fingers pulled apart cranially and caudally. >1 scissors cut on the peritoneum and it's opened with 2 fingers (Ienter the peritoneum with one finger) > >no opening of the visceral peritoneum (I do a bladder flap) >the uterus is opened like the fascia (same) > >the kid is taken out, and so the placenta > >the uterus is exteriorised (most of the times - really fat ladies it's better "in situ") > >On layer closure with a continuous suture of #1 Vicryl® >I put a figure of 8 on my side and begin the suture on the other side >(figure of 8) to end on the first knot on my side (I use Vicryl 0 - figure 8 if messy) > >no closure of the peritoneum (same) > >closure of the fascia with a 2/0 Vicryl in the same way as the uterus (no >fig of 8 knots). (Vicryl 0) > >staples for the skin (most of the times - sometimes monocryl sc) > >Bulent Potur wrote >> For example do you really close the skin with >> only three separated stiches? > >-- >a bit more > >> Do you open nearly the whole fascia with >> caudal and cranial traction? > >-- >yes > >> Do you use no 1 polyglactin or no 1 chromic >> for one layer uterine closure? > >-- >yes > >> Do you believe that the absorbtion time >> of polyglactin is so long that it can protrude through vagina several >> months after the operation? > >-- >never seen that in 20 years since my residency > >> Can you easily perform the operation in >> repeat cases or do yo have to rely on scissors more on them? > >-- >in repeat cases, according to adhesions, scissors are more useful, indeed. > >-- >Bernard Cristalli MD AMACOG >AIHP - ACCA >Paris France >http://www.CliniquedelEssonne.fr >http://www.obgyn.net/corresp/cristalli.htm >http://www.gyneweb.fr >'64 Mk2 3.8 > >> De : bpotur@ttnet.net.tr (Dr. Bülent Potur) >
-- "The opposite of a correct statement is a false statement. But the opposite of a profound truth may well be another profound truth."
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