Anatomy of Surgical Incisions

Question 1

What does LSCS stand for?

Answer 1

Lower segment caesarean section

Question 2

Label these incisions

Answer 2

Question 3

What are the layers of the anterolateral abdominal wall?

Answer 3

skin

superficial fascia

rectus sheath

rectus abdominis (anterior)

external oblique, internal oblique, transversus abdominis (anterolateral)

Question 4

What is the linea alba?

Answer 4

midline blending of aponeuroses

runs from the xiphoid process to the pubic symphysis

Question 5

What direction do the fibres of the external and internal obliques run in?

Answer 5

The same direction as the external and internal intercostals

Question 6

What seperates each rectus abdominis?

Answer 6

tendinous intersections

Question 7

Where is the rectus sheath?

Answer 7

immediately deep to superficial fascia

Question 8

What is the rectus sheath?

Answer 8

combined aponeuroses of anterolateral abdominal wall muscles

strong fibrous layer

Question 9

What does the rectus sheath surround?

Answer 9

rectus abdominis muscles

Question 10

What is incised anteriorly in a suprapubic incision?

Answer 10

rectus sheath

Question 11

What incision is used for an LSCS?

Answer 11

suprapubic

Question 12

What is the nerve supply to the anterolateral abdominal wall?

Answer 12

7th-11th intercostal nerves - become thoracoabdominal nerves

T12 - subcostal

L1 - iliohypogastric and ilioinguinal

Question 13

What blood vessels supply the anterior abdominal wall?

Answer 13

superior and inferior epigastric arteries

Question 14

What is the inferior epigastric artery a branch of?

Answer 14

external iliac artery

Question 15

Where do the superior and inferior epigastric arteries anatomose?

Answer 15

roughly at the umbilicus

Question 16

In relation to the deep inguinal ring, where is the inferior epigastric artery?

Answer 16

just medial to it

Question 17

What is the superior epigastric artery a continuation of?

Answer 17

the internal thoracic artery

Question 18

In relation to rectus abdominis, where do the inferior and superior epigastric arteries lie?

Answer 18

posterior

Question 19

What is the blood supply to the lateral abdominal wall?

Answer 19

intercostal and subcostal arteries

Question 20

Label these arteries.

Answer 20

Question 21

What are the intercostal and subcostal arteries continuations of?

Answer 21

posterior intercostal arteries

Question 22

When incising muscle, what direction do you go in?

Answer 22

to minimise traumatic injury to muscle fibres, incise in the same direction as the muscle fibre

Question 23

What happens to the rectus muscles in an LSCS?

Answer 23

they are seperated from each other in a lateral direction (NOT CUT)

with fingers - want to go with natural lines of weakness

Question 24

What procedures are performed to protect the bladder in an LSCS?

Answer 24

uterovesical fold deflected down to keep bladder away from where you are cutting

Question 25

What increases the chances of wound complications in a midline incision?

Answer 25

its relatively bloodless which means healing is not as good

Question 26

What must be avoided when inserting a lateral port?

Answer 26

the inferior epigastric artery

Question 27

How can the inferior epigastric artery be avoided?

Answer 27

- emerges just medial to the deep inguinal ring (halfway between ASIS and pubic tubercle) - passes superomedially posterior to the rectus abdominis - a few inches either side of umbilicus avoid these areas

Question 28

How can you tell between the ureter and uterine artery during a hysterectomy?

Answer 28

ureter passes inferior to artery ureter often 'vermiculates' when touched (like a worm)

Question 29

What are the layers that you have to go through in an LCSC?

Answer 29

skin superficial fascia deep fascia anterior rectus sheath rectus abdominus transversalis fascia extra peritoneal connective tissue peritoneum uterus

Question 31

Which artery is most likely to be the cause of bleeding during an insertion of a lateral port, during female laparascopic sterilisation?

Answer 31

inferior epigastric

Question 32

Which artery is most likely to be the source of bleeding in an incision of a Bartholin's abscess?

Answer 32

internal pudendal

Question 33

Which artery is most liklely to be the source of bleeding in a dissection of the lower end of the ureter?

Answer 33

uterine artery 'water under the bridge' - ureter passes under uterine artery