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(A) Three 6–0 nylon sutures with simple double knots are placed around the ribs superior to the 4th rib and inferior to the 5th rib. (B) Use hemostats in both hands to gather the three sutures together and increase the PEEP to 6 cmH2O in the ventilation settings. (C) Tie together all three knots at the same time by pulling up and away to close the wound, decrease PEEP to 2 cmH2O immediately, and close skin with 6–0 nylon suture.
