Chapter 5: Table of Contents
TIPS TO REMEMBER WHEN PERFORMING ABDOMINAL SURGERY:
- Do not grab skin with forceps!
- Use the pencil grip on the thumb forceps (they are not tweezers or barbecue tongs).
- Do not dissect too wide creating lots of dead space but expose the linea alba well enough to identify where to enter and to help ensure you include the external rectus fascia when closing the abdominal cavity.
- Do not pull long suture strand too far away from your surgical site. Instead, re-grasp the suture material closer to the surgical field to prevent contamination (on the light or surgical mask). Keep instruments, hands and suture within the surgical field / sterile area at all times.
- When tying knots, keep the suture ends loose, watch the knot form, keep your hands parallel (flat) to prevent forming slip knots. Tie your knots slowly to ensure good apposition (don’t rush).
- Do not manipulate / grasp the suture strand with needle holders or other instruments other than at the tip / end of the suture that will be cut / removed. Instruments damage the suture strand.
- Follow the curve of the needle when passing through tissues to prevent excessive tissue trauma. Grasp the suture needle with instruments (not fingers) when pulling it out of the tissues.
- Do not use surgeon throws unless there is tension on the tissues or a lot of fat on the pedicle. Include the external rectus fascia in all bites when closing the abdominal wall. It is the layer of strength.
- Take bites close to the skin when closing the subcutaneous tissues in order to appose the skin fairly closely. This decreases tension on the skin sutures and allows placement of loose skin sutures to accommodate postoperative swelling. Tack down to the external rectus fascia every 2-3 bites in order to decrease dead space and potential seroma formation. Do not include or damage the linea sutures with your needle.
- Burrying the knot is considered essential and should be performed in the subcutaneous tissues and for intradermal / subcuticular closure. If the knot doesn’t burry, consider placing a single skin suture overtop and removing it before discharge. Do not use tissue glue.
- Replace instruments and gauzes on the instrument table after use and use a single gauze at a time to prevent loosing any in the surgical field.
- Remember to ensure the suture you are using is what you think it is. Keep non-absorbable suture meant for skin closure at the back of the table so you don’t inadvertently use it within the abdominal cavity.
- Intradermal closure must be performed using cutting needle.