By Carol E. H. Scott-Conner MD, PhD (auth.)
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Additional info for Chassin’s Operative Strategy in General Surgery: An Expositive Atlas
When taking large bites of tissue with considerable tensile strength, such as with the Smead-Jones closure of the abdominal wall, heavier suture material is indicated. Here, 1-0 PDS is suitable. Obviously, the size of the suture material must be proportional to the strength of the tissues into which it is inserted and to the strain it must sustain. Continuous versus Interrupted Sutures End-to-end anastomosis of the GI tract should be done with interrupted seromuscular sutures to avoid the possibility that the purse-string effect of the continuous stitch would narrow the lumen.
Then reapply the gauze pads to provide lateral traction against the subcutaneous fat; use the belly of the scalpel blade to carry the incision down to the linea alba, making as few knife strokes as possible. The linea alba can be identilled in the upper abdomen by observing the decussation of fascial ftbers. It can be conftrmed by palpating the tip of the xiphoid, which indicates the midline. The former custom of discarding the scalpel used for the skin incision (in the belief that it incurred bacterial contamination) is not supported by data or logic and is no longer observed.
This positioning directs the point of the needle toward the surgeon's left foot at all times. -----J Fig. 2-5 Importance of Surgeon's Foot and Body Position Figures 2-6 and 2-7, where Cushing sutures are being inserted into a low-lying colorectal anastomosis. Of course, if the surgeon chose to use the Fig. 2-6 11 Lembert-type suture for an esophagogastrostomy or a coloproctostomy, a single stance would be efficient for the entire anastomosis. 12 Mechanical Basics of Operative Technique J / . R Fig.
Chassin’s Operative Strategy in General Surgery: An Expositive Atlas by Carol E. H. Scott-Conner MD, PhD (auth.)