Anatomy of Surgical Incisions

Question 1

What are some common O & G incisions?

Answer 1

Lower segment C-section = suprapubic incision
Laparotomy = vertical midline incision
Laparoscopy = subumbilical incision
Abdominal hysterectomy = vertical midline incision

Question 2

Where do the external obliques attach?

Answer 2

Attach between lower ribs and iliac crest, pubic tubercle and linea alba

Question 3

What direction do the fibres of the external obliques go in?

Answer 3

Fibres run in same direction as external intercostals

Question 4

Where do the internal obliques attach?

Answer 4

Attach between the lower ribs, thoracolumbar fascia, iliac crest and linea alba

Question 5

What direction do the fibres of the internal obliques go in?

Answer 5

Fibres run in same direction as internal intercostals

Question 6

What are the attachments of the transversus abdominis?

Answer 6

Attach between lower ribs, thoracolumbar fascia, iliac crest and linea alba

Question 7

What is the purpose of the tendinous intersections of the rectus abdominus?

Answer 7

Divide each rectus abdominis into 3 or 4 smaller muscles

Question 8

What forms the linea alba?

Answer 8

Interweaving of muscle aponeuroses = runs from xiphoid process to pubic symphysis

Question 9

Where is the rectus sheath located?

Answer 9

Immediately deep to superficial fascia

Question 10

What is the rectus sheath?

Answer 10

Combined aponeuroses of anterolateral abdominal wall muscles

Question 11

What does the rectus sheath surround?

Answer 11

Rectus abdominis muscles

Question 12

How is the rectus sheath incised during a suprapubic incision?

Answer 12

Incised anyeriorly

Question 13

Where does the nerve supply of the anterolateral abdominal wall enter from?

Answer 13

Enters from the lateral direction

Question 14

What is the nerve supply to the anterolateral abdominal wall?

Answer 14

7th-11th intercostal = become thoracoabdominal nerves

Subcostal (T12), iliohypogastric (L1), ilioinguinal (L1)

Question 15

What is the blood supply to the anterior abdominal wall?

Answer 15

Superior epigastric arteries and inferior epigastric arteries

Question 16

What are some features of the superior epigastric arteries?

Answer 16

Continuation of the internal thoracic arteries

Emerge at superior aspect of abdominal wall

Question 17

What are some features of the inferior epigastric arteries?

Answer 17

Branch of the external iliac artery

Emerge at inferior aspect of the abdominal wall

Question 18

What is the blood supply of the lateral abdominal wall?

Answer 18

Intercostal and subcostal arteries = continuations of posterior intercostal arteries, emerge at lateral aspect

Question 19

What are the principles when incising muscle?

Answer 19

Minimise traumatic injury to muscle fibres = incise in same direction as muscle fibre
Avoid damaging nerves and interrupting blood supply

Question 20

How is a lower segment C-section carried out?

Answer 20

Rectus muscle not cut = separated from each other in lateral direction

Question 21

What are the layers encountered when opening during a lower segment C-section?

Answer 21

Skin and fascia, anterior rectus sheath, rectus abdominis, fascia and peritoneum, (retract bladder), uterine wall, amniotic sack

Question 22

What are the layers that have to be stitched closed after a lower segment C-section?

Answer 22

Uterine wall with visceral peritoneum, rectus sheath, skin

Question 23

What are the layers encountered when opening during a laparotomy?

Answer 23

Skin and fascia, linea alba, peritoneum

Question 24

What are the layers that have to be stitched closed after a laparotomy?

Answer 24

Peritoneum and linea alba, fascia skin

Question 25

What kind of incision is used for a laparotomy?

Answer 25

Midline incision = relatively bloodless, increases chance of wound complications

Question 26

What kind of incision is used for a laparoscopy?

Answer 26

Subumbilical incision

Question 27

What must care be taken to avoid if a lateral port is needed during a laparoscopy?

Answer 27

Must avoid the inferior epigastric artery

Question 28

How can view of the organs during a laparoscopy be improved?

Answer 28

Position of uterus can be manipulated by grasping the cervix with forceps inserted through vagina

Question 29

Where does the inferior epigastric artery emerge?

Answer 29

Just medial to the deep inguinal ring = passes in superomedial direction posterior to rectus abdominis

Question 30

What occurs in an abdominal hysterectomy?

Answer 30

Removal of uterus via an incision in the abdominal wall

Question 31

What occurs in a vaginal hysterectomy?

Answer 31

Removal of uterus via vagina

Question 32

What structures must be differentiated from each other during a hysterectomy?

Answer 32

Ureter and uterine artery

Question 33

How can the ureter be distinguished from the uterine artery?

Answer 33

Ureter passes inferior to artery | Ureter will often vermiculate when touched