abdominal incisions and closures Flashcards
Maylard incision
Transect rectus muscles, ligate inferior epigastric vessels. This doesn’t separate sheath from rectus.
Joel-Cohen advantage
Minimize sharp dissection which equals faster entry. Less fever/pain/blood loss/operative time.
Define Joel-Cohen incision
- straight skin incision
- 3cm below or at ASIS extending 15-17 cm long
- this enters fascia above arcuate line and so you don’t need to separate muscles from the sheath
- stretch the rectus muscles slowly laterally which moves the fat and blood vessels out of the way too
- enter peritoneum transversely (pull up and down)
Cherney advantage
Excise rectus tendon from pubis which creates exposure to retropubic space of Retzius and other deep pelvic structures
mass closure indications
obesity
infection
poor nutrition
steroid treatment
radiotherapy
chemotherapy
any debilitating condition
Smead Jones mass closure indication
reduce dehiscence
- basically a vertical mattress suture (far- far, near-near)
- far-far includes subcutaneous fat, rectus muscle, rectus sheath, fascia, muscle, peritoneum
- near-near includes medial edge of sheath
- better than mass closure because it reapproximates fascial edges
when to close subq tissue
> 2 cm.
don’t place a subq drain
indications for abd vertical incision
better exposure and can extend
less blood loss
quicker entry time
decreased nerve damage
Absorption time of plain catgut
7 days
Absorption time of chromic catgut
14 days
Absorption time of vicryl
21 days = loss of 50% tensile strength
Absorption time of Dexon
what is dexon (braided glycolic acid polymer)
25-30 days = loss of 50% tensile strength
Absorption time of PDS
60 days = loss of 50% strength
Breakdown by inflammation
catguts - plain and chromic
