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Figure 24-1 A, Buried absorbable sutures in the subcutaneous tissues and nonabsorbable sutures to approximate the skin margins. B and B\ Continuous sutures applied obliquely and transversely. C, Mattress (quilt) or right-angle suturing of the skin.

Non-obsorbai>I*; suUires

Figure 24-1 A, Buried absorbable sutures in the subcutaneous tissues and nonabsorbable sutures to approximate the skin margins. B and B\ Continuous sutures applied obliquely and transversely. C, Mattress (quilt) or right-angle suturing of the skin.

Non-obsorbai>I*; suUires

Figure 24-2 Everting the skin edge sharply so that the suture penetrates at the same distance from the edge on both deep and superficial surfaces.

Figure 24-3 A, End-on interrupted mattress suture. Band B', Continuous lock-suture.

Figure 24-4 Subcuticular closure of subcutaneous tissues and skin. A, The first suture is used to approximate the deep fat and includes Scarpa's fascia. B, The second suture closes the intermediate fat layer. C, The third suture runs immediately beneath the skin and approximates it. D, Closure completed. As indicated by arrows, the sutures are run back and forth to ensure they are free and can be easily removed. Stainless-steel wire, nylon, or polypropylene may be used for this closure. (From Coller, F.A., and MacLean, K.F.: In Cole, W.H. fed.J: Operative Technic in General Surgery. New York, Appleton-Century-Crofts, 1949, with permission.)

Figure 24-5 Method of placing a subcuticular suture and a variety of methods of fixing its ends.

Figure 24-6 Method of closure of the abdominal wall with stainless-steel wire. (From Halevy, A., Oland, Y., and Adam, Y.G.: Stainless steel wire for closure of abdominal operative wounds. Am. Surg., 44:342, 1978, with permission.)

Figure 24-8 A, Through-and-through wire suture. B, Correct and incorrect way of twisting wire ends. C, Wire sutures placed and secured.

Figure 24-8 A, Through-and-through wire suture. B, Correct and incorrect way of twisting wire ends. C, Wire sutures placed and secured.

Figure 24-9 Continuous suture. A, Initial knot tied intraperitoneally. B and D, Large tissue inclusion 2.5 to 4 cm from incision. C, Suture advancing 1 to 1.5 cm. (From Martyak, S.N., and Curtis, L.E.: Abdominal incision and closure. Am. J. Surg., 131:476, 1976, with permission.)

Figure 24-12 Abdominal wall closure with synthetic absorbable basting suture reinforced with fascial staples. The fascial staples are shown perpendicular to the fascial closure line. (From Elliot, T.E., Albertazzi, V.J., and Dan to, L.A.: A new technique for abdominal wall closure. Surg. Gynecol. Obstet, 145:425, 1977. By permission of Surgery, Gynecology and Obstetrics.)

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