Anatomy of Surgical Incisions Flashcards
What does LSCS stand for?
Lower segment caesarean section
Label these incisions
What are the layers of the anterolateral abdominal wall?
skin
superficial fascia
rectus sheath
rectus abdominis (anterior)
external oblique, internal oblique, transversus abdominis (anterolateral)
What is the linea alba?
midline blending of aponeuroses
runs from the xiphoid process to the pubic symphysis
What direction do the fibres of the external and internal obliques run in?
The same direction as the external and internal intercostals
What seperates each rectus abdominis?
tendinous intersections
Where is the rectus sheath?
immediately deep to superficial fascia
What is the rectus sheath?
combined aponeuroses of anterolateral abdominal wall muscles
strong fibrous layer
What does the rectus sheath surround?
rectus abdominis muscles
What is incised anteriorly in a suprapubic incision?
rectus sheath
What incision is used for an LSCS?
suprapubic
What is the nerve supply to the anterolateral abdominal wall?
7th-11th intercostal nerves - become thoracoabdominal nerves
T12 - subcostal
L1 - iliohypogastric and ilioinguinal
What blood vessels supply the anterior abdominal wall?
superior and inferior epigastric arteries
What is the inferior epigastric artery a branch of?
external iliac artery
Where do the superior and inferior epigastric arteries anatomose?
roughly at the umbilicus
In relation to the deep inguinal ring, where is the inferior epigastric artery?
just medial to it
What is the superior epigastric artery a continuation of?
the internal thoracic artery
In relation to rectus abdominis, where do the inferior and superior epigastric arteries lie?
posterior
What is the blood supply to the lateral abdominal wall?
intercostal and subcostal arteries
Label these arteries.
What are the intercostal and subcostal arteries continuations of?
posterior intercostal arteries
When incising muscle, what direction do you go in?
to minimise traumatic injury to muscle fibres, incise in the same direction as the muscle fibre
What happens to the rectus muscles in an LSCS?
they are seperated from each other in a lateral direction (NOT CUT)
with fingers - want to go with natural lines of weakness
What procedures are performed to protect the bladder in an LSCS?
uterovesical fold deflected down to keep bladder away from where you are cutting
What increases the chances of wound complications in a midline incision?
its relatively bloodless which means healing is not as good
What must be avoided when inserting a lateral port?
the inferior epigastric artery
How can the inferior epigastric artery be avoided?
- emerges just medial to the deep inguinal ring (halfway between ASIS and pubic tubercle)
- passes superomedially posterior to the rectus abdominis
- a few inches either side of umbilicus
avoid these areas
How can you tell between the ureter and uterine artery during a hysterectomy?
ureter passes inferior to artery
ureter often ‘vermiculates’ when touched (like a worm)
What are the layers that you have to go through in an LCSC?
skin
superficial fascia
deep fascia
anterior rectus sheath
rectus abdominus
transversalis fascia
extra peritoneal connective tissue
peritoneum
uterus
Which artery is most likely to be the cause of bleeding during an insertion of a lateral port, during female laparascopic sterilisation?
inferior epigastric
Which artery is most likely to be the source of bleeding in an incision of a Bartholin’s abscess?
internal pudendal
Which artery is most liklely to be the source of bleeding in a dissection of the lower end of the ureter?
uterine artery
‘water under the bridge’ - ureter passes under uterine artery
