Read e-book online Chassin’s Operative Strategy in General Surgery: An PDF

By Carol E. H. Scott-Conner MD, PhD (auth.)

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Sample text

For example, a sideto-side functional end-to-end anastomosis is an easy way to create an ileocolonic anastomosis after right hemicolectomy because it eliminates the problems previously described for joining bowel of varying size. SUTURE MATERIAL Absorbable Sutures Plain Catgut Plain catgut is not commonly used during modem surgery. Although its rapidity of absorption might seem to be an advantage, this rapidity is the result of an intense inflammatory reaction that produces enzymes to digest the organic material.

These sutures are placed so they include 8-10 mm of tissue with each bite, as shown in Figure 4-10. Except for use in the McBurney and Pfannenstiel inciSions, this abdominal wall closure should be considered obsolete. Continuous Simple Over-and-Over Stitch Continuous Subcuticular Stitch For the continuous subcuticular stitch, 4-0 PG may be employed on an atraumatic, curved, cutting needle. With practice the surgeon may insert it rapidly and obtain a good cosmetic result (Fig. 4-8). Because it is absorbable there are no sutures to remove postoperatively.

During a subcostal or thoracic incision) may be accomplished efficiently when the electrocautery is set for "coagulation" or "blend" current. This setting provides good hemostasis and appears not to injure the patient Significantly. Occasionally, the peritoneum and ligaments in the paracolic gutters are somewhat vascular secondary to inflammation. Electrocautery can be used here to divide these normally "avascular" structures. 17 In many areas, such as the neck, breast, and abdominal wall, it is feasible to cut with electrocautery, now set for "cutting," without causing excessive bleeding.

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