Closing a thick subcutaneous layer efficiently.

Explore our veterinary resources: focusandflourish.com 🔗 Download our free OR Checklist here: https://focusandflourish.myflodesk.com/free-or-checklist Closing thick or deep subcutaneous layers presents challenges in surgery. In overweight patients or deep regions such as the axilla or groin, a single-layer closure may leave dead space or misaligned skin edges. Dr. Sylvestre demonstrates a two-layer technique that strengthens the closure and reduces postoperative complications. The Problem with Single-Layer Closures In very deep subcutaneous layers, a single-layer closure often leaves dead space, which can lead to fluid accumulation, swelling, and increased tension on skin edges. This is particularly problematic in high-motion areas near the hind limbs. One layer may not provide sufficient strength to approximate deep tissues and align the skin simultaneously. The Strategic Two-Layer Approach Dr. Sylvestre recommends a layered closure to address both tissue depth and skin edge approximation: 1. Begin the deep layer by placing simple interrupted sutures in the deepest part of the incision. * Use a deep-to-superficial followed by a superficial-to-deep suture pattern to ensure the knot remains buried. * This layer primarily eliminates dead space at the base of the incision. 2. Once the deep space is closed, proceed with a simple continuous suture in the superficial subcutaneous tissue. * This layer should target the connective tissue beneath the skin that contains the subdermal plexus. * The goal is to approximate the skin edges. Upon completing this layer, the skin should be well aligned and tension-free before placing the final skin sutures. Critical Techniques for Success * Always start the continuous layer with a buried knot, using a deep-to-superficial followed by a superficial-to-deep path. This prevents irritation and avoids interference with skin healing. * Deep closures are particularly important near the limbs, where frequent movement increases the risk of fluid accumulation and swelling. * To finish a continuous subcutaneous To complete a continuous subcutaneous suture, place a stitch across the incision and leave a loop. Then, take a final stitch from superficial to deep so the needle exits in the center of the incision beside the loop. Tie the suture tail to the loop to create a secure, buried knot. The deep layer is to stop fluid from building up in the wound. * A well-executed subcutaneous closure should result in skin edges meeting before any skin sutures are placed. * For optimal superficial closure, focus on the connective tissue layer containing the subdermal plexus. Timestamps: 0:00 Introduction & Scenario Overview 0:23 Challenges with Deep Subcutaneous Closures 0:55 Deep Subcutaneous Closure Technique (First Layer) 1:54 Superficial Subcutaneous Closure Technique (Second Layer) 3:13 Benefits of Two-Layer Closure 4:03 Completing the Closure & Final Knot 5:24 Conclusion This video is intended for veterinary professionals and is not a substitute for formal veterinary training or clinical judgment. #veterinarymedicine #veterinary #veterinarysurgeon #veterinariantips #vet #focusandflourish