Now we have reached the stage of closing the abdomen
we don't close the p pereotneum
which heals by itself in a few days
in some cases you will see that some surgeons will approximate the rectus abdominus muscle
but that not also necessary
as you can see now the first step of closing the abdomen is closing the rectus sheath
so the rectus sheath or the fascia will be closed by usually
Vicryl
and the first step would be to start from the angles and we are going to suture
it in a continuous nonlocking sutures
and when we are closing the fascia is to make sure is that
the firstly that the knot we use at the first site where we are going to do the knot at the angle should be
locked very well, and the knot should be tight and locked at least four to five times
and then when we are doing the continuous suture we should at least in each margin
go inside 1.5 cm inside the rectus sheath so that we avoid any risk
of tearing of the surture and subsequent dehiscence of the wound
so we should make sure we should grasp enough of the rectus sheathh at least 1.5 cm from the margin of the wound
while we are doing the continuous suture
so once we reach the other end of the wound we should make sure just like we did
at the closure of the facia at the first end
we should make sure the knot is strong and the knot is repeated at least four or five times
and then the next step after we are finished with this
we should make sure there are no bleeders inside the subcutaneous fat
and occasionally if it is a very deep subcutaneous fat we may do a some
interrupted stitch in the subcutaneous fat to avoid a big dead space that could result in subsequent infection
but if it is not a deep one then we don't need to put any stitches in the subcutaneous fat
and then in the final stage of the procedure
is closing the skin
so the skin would be usually closed by a
subcuticular stitch that you can see now
using a 2 O or a 3 O stitch
it will be a subcuticular continuous stitch that we are going to apply
So after we are done with the closure of the skin
before we dress the wound we have to clean it
again with some povodone iodine then we put a sterile dressing
and tape the wound
and after we are done with this
we also have to check and clean the vagina
of the woman for any clots, accumulating clots
so we'd have to do this with assistance