Surgical Incisions Flashcards

1
Q

Give examples of common surgical incisions used in obs and gynae practice.

A
  • Lower segment Caesarean section (LSCS)
  • Midline Laparotomy
  • Abdominal (and vaginal) hysterectomy
  • Laparoscopy
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2
Q

What is the “rectus sheath” in the abdomen and why is it clinically relevant to surgical incision?

A
  • immediately deep to superficial fascia
  • Made up of combined aponeuroses of anterolateral abdominal wall muscles
  • surrounds rectus abdominis muscles
  • strong, fibrous layer stitched closed after operation
    => increase strength of the wound
    => reduce complications e.g. incisional hernia
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3
Q

Which of the anterior or posterior rectus sheath will be cut during a caesarean section incision?

A

anterior rectus sheath will be cut

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4
Q

What is the nerve supply to the anterolateral abdominal wall, and why is this clinically relevant to surgical incision?

A
  • 7th-11th intercostal nerves
    (thoracoabdominal)
  • subcostal (T12)
  • iliohypogastric (L1)
  • ilioinguinal (L1)
  • May be injured during surgery
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5
Q

What is the blood supply to the anterolateral abdominal wall?

A
  • Anterior abdominal wall
    => superior epigastric arteries (from internal thoracic)
    => inferior epigastric arteries (from external iliac artery)

Lateral abdominal wall
- intercostal and subcostal arteries (from posterior intercostal arteries)

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6
Q

How should surgeons aim to minimise traumatic injury to muscle fibres whilst completing an incision?

A

incise in same direction as muscle fibre

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7
Q

The rectus abdominis muscles are not cut in a lower segment caesarean section incision. TRUE/FALSE?

A

TRUE

  • Rectus muscles are not cut
  • separated from each other in lateral direction
  • moving them toward their nerve supply
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8
Q

What layers must be passed through during an LSCS incision?

A
  • Skin and fascia
  • (anterior) Rectus sheath
  • separate Rectus abdominis laterally
  • Fascia and peritoneum
  • Retract bladder (urinary catheter already inserted)
  • Uterine wall
  • Amniotic sac
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9
Q

What layers must be stitched closed after completion of an LSCS incision?

A
  • Uterine wall with visceral peritoneum
  • Rectus sheath
  • Fascial layer if increased BMI
  • Skin
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10
Q

What layers are incised into and stitched back up during a laparotomy procedure?

A

Incise

  • Skin and fascia
  • Linea alba
  • Peritoneum

Layers to stitch closed:

  • Peritoneum & Linea alba
  • Fascia (if increased BMI)
  • Skin
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11
Q

Why is healing poorer in a midline incision?

A
  • lack of good blood supply
    => poor healing
    => increases chance of wound complications e.g. dehiscence, incisional hernia
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12
Q

How many ports are normally needed if a laparoscopic approach is being used?

A
  • sub-umbilical incision may be all that is required

- sometimes a lateral port is required

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13
Q

What structure must be avoided if a lateral port is needed?

A

inferior epigastric artery
- emerges medial to deep inguinal ring
(half way between ASIS and pubic tubercle)

  • passes in superomedial direction posterior to the rectus abdominis
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14
Q

How can the position of the uterus be manipulated during a laparoscopic procedure?

A

Manipulated by grasping cervix with forceps inserted through the vagina

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15
Q

What is an abdominal hysterectomy and what incision is used to complete this procedure?

A
  • removal of uterus via incision in the abdominal wall

- same incision as for LSCS

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16
Q

What is a vaginal hysterectomy?

A

removal of uterus via the vagina

17
Q

How can the ureter and the uterine artery be differentiated during hysterectomy?

A
  • the ureter passes inferior to the artery (“water under
    the bridge”)
  • ureter will often “vermiculate” when touched