Anatomy 7 - Anatomy of O&G Surgical Incisions Flashcards
What type of incision is made for a lower segment caesarean section?
Suprapubic incision
What are another 2 names for a suprapubic incision?
Pfannenstiel incision
Bikini-line incision
What type of incision is made for a laparotomy?
Vertical midline incision
What type of incision is made for an abdominal hysterectomy?
Suprapubic
When making an incision, what lines should be followed where possible?
Langer lines
What abdominal muscle runs down the centre of the abdomen?
Rectus abdominis
What is the rectus abdominis contained within?
Rectus sheath
What forms the rectus sheath?
The aponeurosis of the transverse abdomens and the external and internal oblique muscles
What are the 3 layers of muscles from external to internal at the sides of the abdomen?
External oblique
Internal oblique
Transversus abdominis
What is the name of the single midline fibrous line in the anterior abdominal wall formed by the median fusion of the layers of the rectus sheath medial to the bilateral rectus abdomens muscle?
Linea alba
What does the external oblique attach between?
Lower ribs
Iliac crest
Pubic tubercle
Linea alba
In what direction does the external oblique fibres run?
Same as external intercostals (hands in pocket)
What does the internal oblique attach between?
Lower ribs
thoracolumbar fascia
iliac crest
linea alba
In what direction does the internal oblique fibres run?
Same direction as internal intercostals (up and in)
What does the transversus abdominis attach between?
Lower ribs
thoracolumbar fascia
iliac crest
linea alba
What divides each rectus abdominis into 3 or 4 smaller muscles?
Tendinous intersections
What is the purpose of the tendinous intersections of the rectus abdomens?
Improved mechanical efficiency
What does the linea alba run from and to?
Xiphoid process to the pubic symphysis
Described the texture/ strength of the rectus sheath?
Strong fibrous layer (need to stitch it closed)
What can the rectus sheath be divided up into?
Anterior and posterior rectus sheath
When undertaking a suprapubic incision, how is the rectus sheath incised?
Anteriorly
What lies between transversus abdominus and the parietal peritoneum?
Trasversali fascia and extra peritoneal fat
What nerves sensory innervation to the anterolateral abdominal wall? (4)
7th - 11th intercostal nerves (become thoracoabdominal nerves)
Subcostal nerve
Iliohypogastric nerve
Ilioinguinal nerve
Nerve root of subcostal nerve?
T12
Nerve root of iliohypogastric nerve?
L1
Nerve root of ilioinguinal nerve?
L1
How to the nerves to the anterolateral abdominal wall enter?
Lateral direction
What layer of the abdomen does the nerves supplying the anterolateral abdominal wall travel in?
Plane between the internal oblique and the transverses abdominis
What arteries supply the anterior abdominal wall?
Superior epigastric arteries
Inferior epigastric arteries
What artery is the superior epigastric artery a continuation of?
Internal thoracic
What muscle does the superior epigastric artery lie inferior to?
Rectus abdominis
What artery is the external iliac artery a branch of?
External iliac artery
What muscle does the inferior epigastric artery lie posterior to?
Rectus abdominis
What arteries supply the lateral abdominal wall?
Intercostal and subcostal arteries
Is the rectus muscles cut in a lower segment caesarean section?
No
What layers must be stitched closed after a lower segment caesarean section?
Uterine wall with visceral peritoneum
Rectus sheath
(fascial layer if increased BMI)
Skin
What structures need to be opened when carrying out a laparotomy?
Skin and fascia
Linea alba
Peritoneum
Why does the midline incision made when carrying out a laparotomy have an increased chance of wound complications?
Relatively bloodless = healing is not as good
If a lateral port is required in a laparoscopy, care must be taken to avoid what?
The inferior epigastric artery
Where does the external iliac artery emerge from?
Just medial to the deep inguinal ring (half way between ASIS and pubic tubercle)
Where does the ureter pass in relation to the uterine artery?
Inferior
