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Repro and Sexual Health > Anatomy of Surgical Incisions > Flashcards

Anatomy of Surgical Incisions Flashcards

1
Q

What are common surgical incisions in O&G?

A

Lower segment C/S
Laparotomy
Abdominal (and vaginal) hysterectomy
Laparoscopy

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2
Q

Where is the LSCS incision?

A

Suprapubic
Pfannenstiel
Bikini-line

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3
Q

What are the layers of the anterolateral abdominal wall?

A 
Skin
Superficial fascia 
External oblique
Internal oblique 
Transverse abdominus 
Rectus abdominis/ sheath
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4
Q

Where will the external obliques attach?

A

Lower libs to

Iliac crest, pubic tubercle, linea alba

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5
Q

What is the linea alba?

A

Midline blending of aponeuroses

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6
Q

What direction do the external obliques run in?

A

Same direction as external intercostals

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7
Q

Where do the internal obliques attach to?

A

Lower ribs to
Thoracolumbar fascia
Iliac crest
Linea alba

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8
Q

What direction do the internal obliques run in?

A

Same direction as internal intercostals

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9
Q

Where do the transverse abdominus muscles attach to?

A

Attach between lower ribs to

Thoracolumbar, iliac crest and linea alba

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10
Q

What are the rectus abdominis?

A

Divide each rectus abdominis
3 or 4 smaller muscle
Improved mechanical efficiency

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11
Q

Where does the linea alba run to and from?

A

Xiphoid process to the pubic symphysis

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12
Q

What is the rectus sheath?

A

Combined aponeurosis of anterolateral abdominal wall muscles
Surrounds rectus abdominis muscles
Strong fibrous layer; stitch closed

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13
Q

Where is the rectus sheath found?

A

Immediately deep to the superficial fascia

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14
Q

What rectus sheath is cut in a LSCS?

A

ONLY anterior rectus sheath (no muscles are cut)

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15
Q

What is the nerve supply to the anterolateral abdominal wall?

A

7-11th intercostal nerve; becomes thoracoabdominal nerves
Subcostal (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)

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16
Q

What is the blood supply to the anterior abdominal wall?

A

Superior epigastric arteries

Inferior epigastric arteries

17
Q

What is the origin or the superior and inferior epigastric arteries?

A

Superior; internal thoracic

Inferior; external iliac

18
Q

Where will the superior and inferior epigastric arteries emerge?

A

Superior; superior aspect of abdominal wall. Posterior to the rectus abdominis
Inferior; inferior aspect of abdominal wall. Lies posterior to the rectus abdominus

19
Q

What is the supply to the lateral abdominal wall?

A

Intercostal and subcostal arteries

20
Q

What are the origin arteries of the intercostal and subcostal arteries?

A

Posterior intercostal arteries

21
Q

Where will the intercostal and subcostal arteries emerge?

A

Lateral aspect

22
Q

How can you minimize traumatic injury to the muscle fibres when incising?

A

Incise in same direction as muscle fibre

Avoid damaging motor nerves and interrupting blood supply

23
Q

Are the rectus muscles cut in LSCS?

A

No; separated from each other in a lateral direction

Move TOWARDS nerve supply

24
Q

What layers are opened in a LSCS incision?

A 
Skin and fascia
Anterior rectus sheath 
Rectus abdominis separated laterally 
Fascia and peritoneum 
Retract bladder
Uterine wall 
Amniotic sac
25
Q

What layers are stitched closed in LSCS?

A

Uterine wall with visceral peritoneum
Rectus sheath
Fascial layer if increased BMI
Skin

26
Q

What layers are opened in a laparotomy?

A

Skin and fascia
Linea alba
Peritoneum

27
Q

What are the issues that surround a midline abdominal incision?

A

Relatively bloodless; healing can be poor with increased chance of wound complications (dehiscence, incisional hernia)

28
Q

What incisions can be made for a laparoscopy?

A

Sub-umbilical

Lateral port

29
Q

Why do you need to be careful with a lateral incision for a laparoscopy?

A

Avoid inferior epigastric artery

30
Q

Where can you find the inferior epigastric artery?

A

Medial to the deep inguinal ring

Passes in a superomedial direction posterior to rectus abdominis

31
Q

Where is the deep inguinal ring located?

A

Half way between ASIS and pubic tubercle

32
Q

What is an abdominal hysterectomy?

A

Removal of uterus via an incision in abdominal wall (often same as LSCS)

33
Q

What is a vaginal hysterectomy?

A

Removal of uterus via vagina

34
Q

How can the ureter and uterine artery be differentiated?

A

Ureter passess inferior to the artery

Ureter will vermiculite when touched

Repro and Sexual Health (77 decks)

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