Anatomy of Surgical Incisions Flashcards
What are common surgical incisions in O&G?
Lower segment C/S
Laparotomy
Abdominal (and vaginal) hysterectomy
Laparoscopy
Where is the LSCS incision?
Suprapubic
Pfannenstiel
Bikini-line
What are the layers of the anterolateral abdominal wall?
Skin Superficial fascia External oblique Internal oblique Transverse abdominus Rectus abdominis/ sheath
Where will the external obliques attach?
Lower libs to
Iliac crest, pubic tubercle, linea alba
What is the linea alba?
Midline blending of aponeuroses
What direction do the external obliques run in?
Same direction as external intercostals
Where do the internal obliques attach to?
Lower ribs to
Thoracolumbar fascia
Iliac crest
Linea alba
What direction do the internal obliques run in?
Same direction as internal intercostals
Where do the transverse abdominus muscles attach to?
Attach between lower ribs to
Thoracolumbar, iliac crest and linea alba
What are the rectus abdominis?
Divide each rectus abdominis
3 or 4 smaller muscle
Improved mechanical efficiency
Where does the linea alba run to and from?
Xiphoid process to the pubic symphysis
What is the rectus sheath?
Combined aponeurosis of anterolateral abdominal wall muscles
Surrounds rectus abdominis muscles
Strong fibrous layer; stitch closed
Where is the rectus sheath found?
Immediately deep to the superficial fascia
What rectus sheath is cut in a LSCS?
ONLY anterior rectus sheath (no muscles are cut)
What is the nerve supply to the anterolateral abdominal wall?
7-11th intercostal nerve; becomes thoracoabdominal nerves
Subcostal (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)
What is the blood supply to the anterior abdominal wall?
Superior epigastric arteries
Inferior epigastric arteries
What is the origin or the superior and inferior epigastric arteries?
Superior; internal thoracic
Inferior; external iliac
Where will the superior and inferior epigastric arteries emerge?
Superior; superior aspect of abdominal wall. Posterior to the rectus abdominis
Inferior; inferior aspect of abdominal wall. Lies posterior to the rectus abdominus
What is the supply to the lateral abdominal wall?
Intercostal and subcostal arteries
What are the origin arteries of the intercostal and subcostal arteries?
Posterior intercostal arteries
Where will the intercostal and subcostal arteries emerge?
Lateral aspect
How can you minimize traumatic injury to the muscle fibres when incising?
Incise in same direction as muscle fibre
Avoid damaging motor nerves and interrupting blood supply
Are the rectus muscles cut in LSCS?
No; separated from each other in a lateral direction
Move TOWARDS nerve supply
What layers are opened in a LSCS incision?
Skin and fascia Anterior rectus sheath Rectus abdominis separated laterally Fascia and peritoneum Retract bladder Uterine wall Amniotic sac
What layers are stitched closed in LSCS?
Uterine wall with visceral peritoneum
Rectus sheath
Fascial layer if increased BMI
Skin
What layers are opened in a laparotomy?
Skin and fascia
Linea alba
Peritoneum
What are the issues that surround a midline abdominal incision?
Relatively bloodless; healing can be poor with increased chance of wound complications (dehiscence, incisional hernia)
What incisions can be made for a laparoscopy?
Sub-umbilical
Lateral port
Why do you need to be careful with a lateral incision for a laparoscopy?
Avoid inferior epigastric artery
Where can you find the inferior epigastric artery?
Medial to the deep inguinal ring
Passes in a superomedial direction posterior to rectus abdominis
Where is the deep inguinal ring located?
Half way between ASIS and pubic tubercle
What is an abdominal hysterectomy?
Removal of uterus via an incision in abdominal wall (often same as LSCS)
What is a vaginal hysterectomy?
Removal of uterus via vagina
How can the ureter and uterine artery be differentiated?
Ureter passess inferior to the artery
Ureter will vermiculite when touched
