Anatomy of O&G Surgical Incisions Flashcards
What are the common surgical incisions in O&G
Lower segment caesarean section Laparotomy Abdominal (and vaginal) hysterectomy Laparoscopy
What lines should be used to guide incision if possible?
Langer lines
The external obliques attach between lower ____ and ____ _____, ____ tubercle and ____ ____.
The external obliques attach between lower ribs and iliac crest, pubic tubercle and linea alba.
What is the linea alba
Midline blending of aponeuroses Runs from the xiphoid process to the pubic symphysis
In which direction to external oblique fibres run in?
Same direction as intercostals
Where do the intercostals attach?
Between lower ribs, thoracolumbar fascia, iliac crest and linea alba
Where does the transverses abdomens attach?
Between lower ribs, thoracolumbar fascia, iliac crest and linea alba
Describe the structure of the rectus abdominis
Has tendinous intersections which divide each rectus abdominis into 3 or 4 smaller muscles Improved mechanical efficiency
Where does the rectus sheath lie?
Immediately deep to the superficial fascia
What is the rectus sheath?
Combined aponeurosis of anterolateral abdominal wall muscles
What does the rectus sheath surround?
Rectus abdominis muscles
When undertaking a suprapubic incision e.g. for LCSC, only the ______ rectus sheath will be cut
When undertaking a suprapubic incision e.g. for LCSC, only the anterior rectus sheath will be cut
Why is the rectus sheath stitched closed?
After operation to increase the strength of the wound and reduce the risk of wound complications
In what direction does the nerve supply to anterolateral abdominal wall enters from?
Lateral direction
What do the 7th to the 11th intercostal nerves become?
Thoracoabdominal nerves
What nerve is subcostal nerve
T12
What nerve is the iliohypogastric nerve?
L1
What nerve is the ilioinguinal nerve?
L1
In what plane do the thoracoabdominal nerves travel in?
Between internal oblique and transversus abdominus
What is the blood supply to anterior abdominal wall?
Superior epigastric arteries Inferior epigastric arteries
The superior epigastric arteries are a continuation of the ______ ______. They emerge at _______ aspect of abdominal wall and lie _______ to the rectus abdominis.
The superior epigastric arteries are a continuation of the internal thoracic. They emerge at superior aspect of abdominal wall and lie posterior to the rectus abdominis.
The inferior epigastric arteries are a branch of the ______ _____ _____. They emerge at _______ aspect of the abdominal wall and lie _______ to the rectus abdominis.
The inferior epigastric arteries are a branch of the external iliac artery. They emerge at inferior aspect of the abdominal wall and lie posterior to the rectus abdominis.
What is the blood supply to the lateral abdominal wall?
Intercostal and subcostal arteries
What are the internal and subcostal arteries continuations of?
Posterior intercostal arteries
Where do the internal and subcostal arteries emerge
Lateral aspect of abdominal wall
How can damage be minimised when incising muscle?
Incise in the same direction as muscle fibre Avoid damaging nerves and interrupting blood supply
In a LSCS incision the rectus muscles are ___ ___, instead they are _____ from each other in a ______ direction. Moving them towards their _____ ____.
In a LCSC incision the rectus muscles are not cut, instead they are separated from each other in a lateral direction. Moving them towards their nerve supply.
What layers are seen when opening in LSCS?
- Skin and fascia (anterior)
- Rectus sheath
- Rectus abdominis – separate the muscles laterally
- Fascia and peritoneum
- Retract bladder (a urinary catheter is usually already inserted)
- Uterine wall
- Amniotic sac
What layers are stitched closed after LSCS incision?
Uterine wall with visceral peritoneum
Rectus sheath
Fascial layer if increased BMI
Skin
What are the layers when opening for laparotomy?
Skin and fascia
Linea alba
peritoneum
What layers are stitched closed after laparotomy?
Peritoneum and linea alba
fascia (if increased BMI)
skin
What is a laparotomy?
Vertical midline incision
Why is healing of a laparotomy not as good?
Relatively bloodless
Can mean that healing is not as good
Increases the chance of wound complications
e.g. dehiscence, incisional hernia
If a lateral port is required in a laparoscopy what must be ensured?
that the inferior epigastric artery is avoided
How can position of uterus be manipulated in laparoscopy?
Grasping the cervix with forceps
Where is the inferior epigastric artery?
Emerges just medial to the deep inguinal ring
- deep inguinal ring located halfway between the ASIS and pubic tubercle
Then passes in a superomedial direction, posterior to the rectus abdominis
How can the ureter be differentiated from the uterine artery?
The ureter passes inferior to the artery- water under the bridge
The ureter will vermiculate when touched
