[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.78,0:00:08.76,Default,,0000,0000,0000,,Now we have reached the stage of closing the abdomen
Dialogue: 0,0:00:08.76,0:00:11.79,Default,,0000,0000,0000,,we don't close the p pereotneum
Dialogue: 0,0:00:11.79,0:00:15.09,Default,,0000,0000,0000,,which heals by itself in a few days
Dialogue: 0,0:00:15.09,0:00:25.44,Default,,0000,0000,0000,,in some cases you will see that some surgeons will approximate the rectus abdominus muscle
Dialogue: 0,0:00:25.44,0:00:28.94,Default,,0000,0000,0000,,but that not also necessary
Dialogue: 0,0:00:28.94,0:00:33.51,Default,,0000,0000,0000,,as you can see now the first step of closing the abdomen is closing the rectus sheath
Dialogue: 0,0:00:33.51,0:00:37.06,Default,,0000,0000,0000,,so the rectus sheath or the fascia will be closed by usually
Dialogue: 0,0:00:37.06,0:00:40.35,Default,,0000,0000,0000,,Vicryl
Dialogue: 0,0:00:40.35,0:00:47.19,Default,,0000,0000,0000,,and the first step would be to start from the angles and we are going to suture
Dialogue: 0,0:00:47.19,0:00:52.80,Default,,0000,0000,0000,,it in a continuous nonlocking sutures
Dialogue: 0,0:00:52.80,0:00:58.25,Default,,0000,0000,0000,,and when we are closing the fascia is to make sure is that
Dialogue: 0,0:00:58.25,0:01:09.42,Default,,0000,0000,0000,,the firstly that the knot we use at the first site where we are going to do the knot at the angle should be
Dialogue: 0,0:01:09.42,0:01:16.43,Default,,0000,0000,0000,,locked very well, and the knot should be tight and locked at least four to five times
Dialogue: 0,0:01:16.43,0:01:23.52,Default,,0000,0000,0000,,and then when we are doing the continuous suture we should at least in each margin
Dialogue: 0,0:01:23.52,0:01:32.69,Default,,0000,0000,0000,,go inside 1.5 cm inside the rectus sheath so that we avoid any risk
Dialogue: 0,0:01:32.69,0:01:39.44,Default,,0000,0000,0000,,of tearing of the surture and subsequent dehiscence of the wound
Dialogue: 0,0:01:39.44,0:01:49.25,Default,,0000,0000,0000,,so we should make sure we should grasp enough of the rectus sheathh at least 1.5 cm from the margin of the wound
Dialogue: 0,0:01:49.25,0:03:06.06,Default,,0000,0000,0000,,while we are doing the continuous suture
Dialogue: 0,0:03:06.06,0:03:10.83,Default,,0000,0000,0000,,so once we reach the other end of the wound we should make sure just like we did
Dialogue: 0,0:03:10.83,0:03:14.97,Default,,0000,0000,0000,,at the closure of the facia at the first end
Dialogue: 0,0:03:14.97,0:03:25.32,Default,,0000,0000,0000,,we should make sure the knot is strong and the knot is repeated at least four or five times
Dialogue: 0,0:03:25.32,0:03:30.75,Default,,0000,0000,0000,,and then the next step after we are finished with this
Dialogue: 0,0:03:30.75,0:03:36.32,Default,,0000,0000,0000,,we should make sure there are no bleeders inside the subcutaneous fat
Dialogue: 0,0:03:36.32,0:03:43.10,Default,,0000,0000,0000,,and occasionally if it is a very deep subcutaneous fat we may do a some
Dialogue: 0,0:03:43.10,0:03:55.17,Default,,0000,0000,0000,,interrupted stitch in the subcutaneous fat to avoid a big dead space that could result in subsequent infection
Dialogue: 0,0:03:55.17,0:04:02.55,Default,,0000,0000,0000,,but if it is not a deep one then we don't need to put any stitches in the subcutaneous fat
Dialogue: 0,0:04:02.55,0:04:05.30,Default,,0000,0000,0000,,and then in the final stage of the procedure
Dialogue: 0,0:04:05.30,0:04:08.40,Default,,0000,0000,0000,,is closing the skin
Dialogue: 0,0:04:08.40,0:04:11.06,Default,,0000,0000,0000,,so the skin would be usually closed by a
Dialogue: 0,0:04:11.06,0:04:16.56,Default,,0000,0000,0000,,subcuticular stitch that you can see now
Dialogue: 0,0:04:16.56,0:04:23.15,Default,,0000,0000,0000,,using a 2 O or a 3 O stitch
Dialogue: 0,0:04:23.15,0:06:09.26,Default,,0000,0000,0000,,it will be a subcuticular continuous stitch that we are going to apply
Dialogue: 0,0:06:09.26,0:06:13.88,Default,,0000,0000,0000,,So after we are done with the closure of the skin
Dialogue: 0,0:06:13.88,0:06:16.43,Default,,0000,0000,0000,,before we dress the wound we have to clean it
Dialogue: 0,0:06:16.43,0:06:26.06,Default,,0000,0000,0000,,again with some povodone iodine then we put a sterile dressing
Dialogue: 0,0:06:26.06,0:06:30.50,Default,,0000,0000,0000,,and tape the wound
Dialogue: 0,0:06:30.50,0:06:33.56,Default,,0000,0000,0000,,and after we are done with this
Dialogue: 0,0:06:33.56,0:06:36.90,Default,,0000,0000,0000,,we also have to check and clean the vagina
Dialogue: 0,0:06:36.90,0:06:40.69,Default,,0000,0000,0000,,of the woman for any clots, accumulating clots
Dialogue: 0,0:06:40.69,0:06:44.69,Default,,0000,0000,0000,,so we'd have to do this with assistance