Transcript Layer Closure

Layer Closure
Pp 305-307
Objectives
 To describe wound layers
 To understand and describe the types of
suture needles used
 To understand the which needles are used on
which layers
Abdominal Wounds
 Closed from inner to outer
 Layers include
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Peritoneum
Fascia
Muscle
Subcutaneous
Subcuticular
Skin
Peritoneum
 Fast-healing membrane
 May not be closed
 If it is closed, a 3-0 absorbable is commonly
used
Fascia
 Tough connective tissue covering the
muscles
 Heals slowly and endures the brunt of wound
stress
 Use heavy-gauge, interrupted,
nonabsorbable sutures
Muscle
 Typically not closed with suture
 Muscles are usually separated and retracted,
not incised
Subcutaneous
 Does not tolerate sutures well
 Surgeons may place a few interrupted
sutures to prevent dead space
 Plain gut most often used
Subcuticular
 Tough connective tissue just beneath the skin
and just above the subcutaneous layer
 Closure of this layer minimizes scarring
 Absorbable preferred, will use nylon
 Small-gauge
Skin
 Interrupted or continuous monofilament,
nonabsorbable sutures on a cutting needle
 Staples
 Polypropylene or nylon
 Vicryl also sometimes used
Needles
 General closure
 Large fascia: CTX, CT, CT-1 (mid-line incision)
 Small fascia: CT-2, CT-3 (lap chole, appy)
 GI

SH
 Skin
 Large skin incisions, drains: FSLX, FSL
 Medium skin incision, drains: FS, FS-1, PS, PS-1
 Small skin incisions: FS-2, FS-3, PS-2, PS-3, P-3
Questions???