Flashcards in Anatomy of Obs and Gynae Surgical Incisions Deck (40)
List the two most common surgical incisions in O+G and their anatomical locations
Lower segment C-section (suprapubic, 'bikini line')
Laparoscopy (vertical midline incision)
Which anatomical lines are used to determine location of incision and layers incised?
List the layers of the anterolateral abdominal wall from superficial to deep
What is the linea alba?
Midline blending of aponeuroses
What is an aponeurosis?
Flat sheet or ribbon of tendon-like material that anchors a muscle or connects it with the part that the muscle moves
List the attachments of external oblique
Lower ribs (5-11)
Describe the orientation of fibres of external oblique
'Hands in pockets'
Same direction as external intercostals - inferomedial
List the attachments of internal oblique
Lower ribs (912)
Thoracolumbar fascia (posterior)
Describe the orientation of fibres of internal oblique
'Hands in chest'
Same direction as internal intercostals - inferolateral
List the attachments of transverse abdominus
Describe the orientation of fibres of transverse abdominus
What structures divide each rectus abdominus into 3 or 4 smaller muscles?
What is the function of tendinous intersections?
Improve mechanical efficiency
List the attachments of rectus abdominus
Xiphoid process and costal cartilages
Pubic bones and pubic symphysis
What is the rectus sheath?
Deep to superficial fascia, strong fibrous layer surrounding rectus abdominus muscles
What is the clinical relevance of the rectus sheath?
Combined aponeuroses of anterolateral abdominal wall muscles
What is the arcuate line?
Horizontal line that demarcates the lower limit of the posterior layer of the rectus sheath
When undertaking a suprapubic incision, both layers of rectus sheath will be present. True/ False?
Only anterior rectus sheath below the arcuate line
List the layers of the internal surface of the abdominal wall, up to the anterolateral abdominal wall muscles
List the spinal nerves that supply the abdominal wall from superior to inferior, and give their nerve roots
7th - 11th intercostal nerves
What do the intercostal nerves become when they leave the thorax and enter the abdomen?
State the course of the nerves that supply the abdominal wall
Travel in plane between internal oblique and transverse abdominus
Describe the blood supply to the anterior abdominal wall
Internal thoracic artery --> Superior epigastric arteries
External iliac artery --> Inferior epigastric arteries
Describe the blood supply to the lateral abdominal wall
Posterior intercostal arteries --> Intercostal and subcostal arteries
The blood supply to the anterior abdominal wall passes posterior to what muscle?
How does a surgeon minimise trauma to muscle fibres?
Incise in same direction as muscle fibre
During a LSCS incision, muscles are cut. True/ False?
Rectus muscles are seperated in lateral direction, moving them towards nerve supply
List the layers when opening, from superficial to deep, in a LSCS incision
Skin + fascia
Anterior rectus sheath
Transverse fascia + peritoneum
List the layers to stitch closed, from deep to superficial, in a LSCS incision
Uterine wall with visceral peritoneum
Fascial layer if increased BMI