WEBVTT

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Now we have reached the stage of closing the abdomen

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we don't close the p pereotneum

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which heals by itself in a few days

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in some cases you will see that some surgeons will approximate the rectus abdominus muscle

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but that not also necessary

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as you can see now the first step of closing the abdomen is closing the rectus sheath

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so the rectus sheath or the fascia will be closed by usually

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Vicryl

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and the first step would be to start from the angles and we are going to suture

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it in a continuous nonlocking sutures

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and when we are closing the fascia is to make sure is that

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the firstly that the knot we use at the first site where we are going to do the knot at the angle should be

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locked very well, and the knot should be tight and locked at least four to five times

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and then when we are doing the continuous suture we should at least in each margin

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go inside 1.5 cm inside the rectus sheath so that we avoid any risk

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of tearing of the surture and subsequent dehiscence of the wound

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so we should make sure we should grasp enough of the rectus sheathh at least 1.5 cm from the margin of the wound

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while we are doing the continuous suture

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so once we reach the other end of the wound we should make sure just like we did

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at the closure of the facia at the first end

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we should make sure the knot is strong and the knot is repeated at least four or five times

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and then the next step after we are finished with this

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we should make sure there are no bleeders inside the subcutaneous fat

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and occasionally if it is a very deep subcutaneous fat we may do a some

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interrupted stitch in the subcutaneous fat to avoid a big dead space that could result in subsequent infection

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but if it is not a deep one then we don't need to put any stitches in the subcutaneous fat

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and then in the final stage of the procedure

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is closing the skin

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so the skin would be usually closed by a

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subcuticular stitch that you can see now

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using a 2 O or a 3 O stitch

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it will be a subcuticular continuous stitch that we are going to apply

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So after we are done with the closure of the skin

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before we dress the wound we have to clean it

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again with some povodone iodine then we put a sterile dressing

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and tape the wound

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and after we are done with this

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we also have to check and clean the vagina

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of the woman for any clots, accumulating clots

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so we'd have to do this with assistance