Abdomen Incisions and the Surgical Wound Flashcards
vertical, skirting around left edge of umbilicus .
incised in line with the linea alba through the subcutaneous fascia, linea alba, transversalis fascia and parietal peritoneaum
wide incision superior to umbilicus and more thin below
midline incision
incision 2.5 to 4 cm lateral and parallel to the midline, the anterior rectus sheath is opened, rectus muscle displaced laterally, then posterior sheath, peritoneum are both incised
paramedian incision
transverse incision is made in the suprapubic skin crease roughly 5cm above the pubic symphysis, about 12cm long, lies below arcuate line.
through skin, subcutaneous fascia, rectus abdomens muscle split along linea alba
in emergency skin and rectus abdomens incised transverse plan
pfannenstiel incision
Incision used for gallbladder, biliary system, pancreas, liver, adrenal gland, portal system
Right subcostal (kocher)
Oblique skin incision made over McBurney’s point in right lower Quadrant. Muscle-splitting incision
McBurney incision
Curved skin incision, which breaches both pleural and abdominal cavities. Continues through rectus abdominus, external oblilque, serratus anterior and intercostal muscles.
Thoracoabdominal incision
Oblique skin incison made 2-5 cm superior and parallel to inguinal crease. Muscle splitting incision; AKA: Lower oblique incision or groin incision
Inguinal incision
muscles involved from outside in
rectus abdominus, internal oblique, transverse abdominus
(Through the fold of umbilicus - commonly used in laparoscopic surgery)
umbilical
used for open heart procedures
median sternotomy
incision made under ideal surgical conditions, no break in sterile technique during procedure, primary closure, no wound drain, no entry to aerodigestive or genitourinary tract
Class I: Clean
Primary closure, wound drained, minor break in sterile technique occurred, controlled entry to aerodigestive (includes biliary) or genitourinary tract
Class II: Clean Contaminated
open traumatic wound less than 4 hours old, major break in sterile technique occurred, acute inflammation present, entry to aerodigestive or genitourinary tract with spillage
Class III: Contaminated
Open traumatic wound more than 4 hours old, microbial contamination prior to procedure, perforated viscus (bowel)
Class IV: Dirty/Infected
When is the final wound classification assigned
assigned at the end of the procedure
removal of devitalized tissue and contaminants
debridement
irrigation/incision and debridement
I&D
Abrasion
scrape
Contusion
bruise
laceration
cut or tear
5 signs of inflammation
pain, heat, redness, swelling, loss of function
three types of wound healing
first intention, second intention, and third intention
healing occurs from side to side in a sterile wound in which dead space has been eliminated; wound tensile strength plateaus at the 3rd month at 70 to 80%
First Intention or Primary Union
occurs when a wound fails to heal by primary union; the wound is left open an allowed to heal from the inner layer to the outside surface
Second intention or granulation
occurs when two granulated surfaces are approximated; the traumatic surgical wound is debrided and left to heal by second intention for 4 to 6 days and then closed and allowed to heal through primary closure
third intention or delayed primary closure
the partial or total separation of a layer or layers of tissue after closure
Dehiscence
exposure of the viscera through the edges of a totally separated wound; emergency situation
evisceration
a separation of internal wound layers that have not been closely approximated, or air that has become trapped between tissue layers
Dead space
3 Phases of wound healing - First Intention/No infection
Inflammatory (lag) phase
Fibroplasic ( proliferative) phase
Remodeling (maturation) phase
Opening or passageway between two organs that normally do not connect
Fistula
Excessive (hypertrophic) scar formation
Keloid Scarring
Protrusion of an organ or tissue from cavity where it is normally found
Herniation
What medicines inhibit wound healing?
Steroids decrease inflammation and respirations slow, vitamin A counterreacts these effects
What kind of drainage is sanguineous?
bloody
What kind of drainage is serous?
Clear drainage
Identify
This is a passive drain, which can be used to create a conduit for drainage.
Penrose Drain
Identify
Passive drain that consists of a round collection reservoir with three springs inside. Usually used when expecting a large amount of drainage.
Hemovac
Drainage system that has a small bulb reservoir. Commonly referred to as a JP Drain
Jackson-Pratt Drain
