Preparing Closure for an Abdomen

In practice

The open abdominal case is nearing its end, and the preference card lists the closing sutures by layer. Sam, the scrub person, reads each package before opening it and confirms it with the circulating nurse. For the fascia, the strong layer of the abdominal wall, the card calls for a heavy absorbable monofilament on a large curved needle; Sam checks the size on the package and that the needle is the type the surgeon wants for that tough tissue. For the subcutaneous layer, a finer absorbable braided suture on a taper needle. For the skin, the card offers a fine nonabsorbable monofilament on a cutting needle or a skin stapler, and the surgeon chooses staples today. Sam loads the fascial suture in a long needle holder for the deep closure, gripping the needle at a right angle a third of the way back from the swage. As each needle comes back, Sam places it straight into the needle counter. Before the fascia is closed, Sam and the circulator do the closing count of sponges, sharps and instruments, and the surgeon examines the abdomen. Then, layer by layer, Sam passes what each layer needs, a step ahead: straight Mayo scissors to cut each tie, then the next suture, then, at skin, the stapler. The final count at skin closure is correct.