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This Concept Map, created with IHMC CmapTools, has information related to: umbilical hernia repair, The skin was carefully dissected and undermined away from the subcutaneous tissue. IF INDICATED Infiltration of local anesthetic (lidocaine) was done intermittently in and around the lines of incision and any excessive bleeding that would obscure view was controlled using a hemostat and gauze., The subcutaneous tissue was closed using subcuticular simple continuous suture pattern using, using PDS 2-0. It was done very close to the skin to prevent a ‘gaping hole’. At the middle and end of suturing, some of the abdominal wall was included inorder to eliminate dead space. The subcuticular was ended with an Aberdeen knot and was buried. NEXT The skin was closed using a combination of cruciate and simple interrupted using Prolene 1. It was performed using the half-way method and it was ensured that the sutures were not done too tight to allow for swelling at the site. At 2 stitches prior to completion, the CRI was stopped., The skin was closed using a combination of cruciate and simple interrupted using Prolene 1. It was performed using the half-way method and it was ensured that the sutures were not done too tight to allow for swelling at the site. At 2 stitches prior to completion, the CRI was stopped. THIS WAS FOLLOWED BY The site being cleaned using water and dilute chlorhexidine, and sprayed with Tetravet antibiotic spray followed by an anti-myiasis spray around the wound., Sutures for closure of the muscles of the abdomen was pre-placed by leaving long ends of the suture material and clamping off using a mosquito forceps. Vest over pants/ pants over vest was the pattern of choice for abdominal muscle and Prolene 0 was used. 6 sutures was used (enough to completely close the hernial ring) ???? VEST OVER PANTS: In the middle of the upper flap the suture is passed through the entire thickness of the abdominal wall from without inwards about two inches from the margin. The needle then takes a strong longitudinal bite through the lower flap near its margin and is carried out through the upper flapone-half inch to the side of the point of entry., The skin was carefully dissected and undermined away from the subcutaneous tissue. NEXT Dissection was continued down until the hernial ring was visualized. The structures were palpated since on physical exam, a mass was felt. The mass was on the ventro-cranial aspect of the hernia. Around the hernial sac was also palpated for any adhesions. None were felt., Sutures for closure of the muscles of the abdomen was pre-placed by leaving long ends of the suture material and clamping off using a mosquito forceps. Vest over pants/ pants over vest was the pattern of choice for abdominal muscle and Prolene 0 was used. 6 sutures was used (enough to completely close the hernial ring) NEXT After pre-placing the sutures, the forceps were drawn up and out and the sutures tightened so as to pull the lower flap well up in under the upper flap and to ensure that proper closure of the muscle will be achieved and that no abdominal contents will be able to come through, and the sutures tied., The free margin of the upper flap was sutured fast to the opposing surface of the lower flap. This was done using the half way method of wound closure About 6 throws was done to ensure knot security. AFTERWARDS The subcutaneous tissue was closed using subcuticular simple continuous suture pattern using, using PDS 2-0. It was done very close to the skin to prevent a ‘gaping hole’. At the middle and end of suturing, some of the abdominal wall was included inorder to eliminate dead space. The subcuticular was ended with an Aberdeen knot and was buried., Dissection was continued down until the hernial ring was visualized. The structures were palpated since on physical exam, a mass was felt. The mass was on the ventro-cranial aspect of the hernia. Around the hernial sac was also palpated for any adhesions. None were felt. THEREFORE, The hernial sac was entered laterally, away from the mass. The mass was then palpated again to determine if it went cranially, caudally or if it stopped (abscess or cyst). It was the latter, therefore the hernial sac was removed with the mass intact to prevent contamination of the abdominal contents., The site being cleaned using water and dilute chlorhexidine, and sprayed with Tetravet antibiotic spray followed by an anti-myiasis spray around the wound. ???? Removal of the skin sutures is to be performed in 10-14 days post op, An elliptical, skin-thickness incision was made around the hernia using a scalpel, blade and forceps. THEN The skin was carefully dissected and undermined away from the subcutaneous tissue., After pre-placing the sutures, the forceps were drawn up and out and the sutures tightened so as to pull the lower flap well up in under the upper flap and to ensure that proper closure of the muscle will be achieved and that no abdominal contents will be able to come through, and the sutures tied. THEN The free margin of the upper flap was sutured fast to the opposing surface of the lower flap. This was done using the half way method of wound closure About 6 throws was done to ensure knot security., The hernial sac was entered laterally, away from the mass. The mass was then palpated again to determine if it went cranially, caudally or if it stopped (abscess or cyst). It was the latter, therefore the hernial sac was removed with the mass intact to prevent contamination of the abdominal contents. ???? Sutures for closure of the muscles of the abdomen was pre-placed by leaving long ends of the suture material and clamping off using a mosquito forceps. Vest over pants/ pants over vest was the pattern of choice for abdominal muscle and Prolene 0 was used. 6 sutures was used (enough to completely close the hernial ring)