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Caesarean Section: Step 6 - Closure of Abdomen

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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
Title:
Caesarean Section: Step 6 - Closure of Abdomen
Description:

This is part of a series of surgical videos for training on Caesarean Section. Viewer discretion is advised: The educational material contained herein may contain medical images that non-professional viewers may find disturbing. The full learning module is available at: http://open.umich.edu/education/med/oernetwork/med/ob-gyn/caesarean-adaptation/2012. The narration is by Dr. Lia Tadesse (St. Paul Hospital Millennium Medical College) in Ethiopia, the procedure is demonstrated by Dr. Richard Adanu (University of Ghana), and the recording was done by Dr. Cary Engleberg (University of Michigan). Along with other resources in the module, this video is shared under a Creative Commons Attribution Noncommercial 3.0 License: http://www.creativecommons.org/licenses/by-nc/3.0/. Video recorded by Dr. Cary Engleberg (University of Michigan). This video is provided by the African Health OER Network (http://www.oerafrica.org/healthoer). Video transcribed by Kathleen Omollo (University of Michigan).

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Video Language:
English
Duration:
06:48

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