Surgical incisions

Question 1

Vertical midline incision - give an example of a procedure

Answer 1

Laparotomy

Question 2

Suprapubic incision - give 2 examples of procedures

Answer 2

Lower Segment Caesarean Section (LSCS)

Hysterectomy

Question 3

Anterolateral abdominal wall - what are the 3 layers of muscle beneath the fascia

Answer 3

External oblique
Internal oblique
Transversus abdominus

Question 4

External oblique - attachments

Answer 4

Ribs 5-11, iliac crest, pubic tubercle, linea alba

Question 5

External oblique - which direction do fibres run?

Answer 5

Hands in pockets orientation

Question 6

Internal oblique - attachments

Answer 6

Ribs 10-12, thoracolumbar fascia, iliac crest, linea alba

Question 7

Where is the rectus abdominus located?

Answer 7

In the midline

Question 8

Rectus abdominus - attachments

Answer 8

Xiphoid process
Costal cartilages
Pubic bones

Question 9

What is the line alba ?

Answer 9

Midline blending of aponeuroses which interlocks and interweaves

Question 10

The linea alba has minor/major vasculature?

Answer 10

Minor vasculature

- won’t bleed much

Question 11

What is the importance of extra peritoneal fat?

Answer 11

Layer of fatty tissue where vessels run

Question 12

Anterolateral abdominal wall nerve supply

Answer 12

7th –> 11th intercostal nerves become thoracoabdominal nerves as they move from lateral –> medial

Question 13

The anterolateral abdominal wall nerve supply travels in the plane between which 2 muscle groups?

Answer 13

Internal oblique and transversus abdominus

Question 14

What is the name of the nerve at T12

Answer 14

Subcostal nerve

Question 15

What is the name of the nerve at L1

Answer 15

Iliohypogastric nerve

Ilioinguinal nerve

Question 16

Blood supply and venous drainage of anterolateral abdominal wall is located in which layer?

Answer 16

Extra peritoneal fat layer

Question 17

Anterior abdominal wall blood supply (2)

Answer 17

Inferior epigastric arteries

Superior epigastric arteries

Question 18

Inferior epigastric arteries are a branch of ?

Answer 18

External iliac artery

Question 19

Inferior epigastric arteries emerge medial/lateral to the deep inguinal ring ?

Answer 19

Medial

Question 20

Superior epigastric arteries are a continuation of what artery ?

Answer 20

Internal thoracic artery

Question 21

Lateral abdominal wall blood supply

Answer 21

Intercostal arteries

Subcostal arteries

Question 22

What lies immediately deep to superficial fascia?

Answer 22

Rectus sheath

Question 23

Incision made above the accurate line

• anterior rectus sheath contents
• posterior rectus sheath contents

Answer 23

Anterior rectus sheath

• external oblique
• anterior leaflet of internal oblique

Posterior rectus sheath

• posterior leaflet of internal oblique
• transversus abdominus

Question 24

Incision made below the accurate line

• anterior rectus sheath contents
• posterior rectus sheath contents

Answer 24

Anterior rectus sheath

• external oblique
• internal oblique
• transversus abdominus

Question 25

Give an example of a surgical incision made below the accurate line?

Answer 25

Lower Segment Caesarean Section

Question 26

LSCS incision is made through which layers ?

Answer 26

``` Skin and fascia Anterior rectus sheath Rectus abdominus Trasversalis fascia and peritoneum RETRACT THE BLADDER Uterine wall (thin) Amniotic sac ```

Question 27

Why is a midline incision relatively bloodless?

Answer 27

At the line alba there is minimal blood supply

Question 28

What is a downside of the line alba having minimal blood supply?

Answer 28

Increased chance of wound healing complications

Question 29

What should you take care to avoid during laparoscopy?

Answer 29

Avoid inferior epigastric artery

Question 30

When carrying out a hysterectomy what care must be taken?

Answer 30

Differentiate the ureter from the uterine artery

Question 31

Uterine artery and ureter relation - ureter passes superior/inferior to the uterine artery?

Answer 31

Inferior | - water under the bridge

Question 32

If the ureter is touched what happens?

Answer 32

It shakes