O and G surgical incisions Flashcards
name 4 types of common O + G surgical incisions
- lower segment caesarean section (LSCS)
- laparotomy
- laparoscopy
- abdominal (and vaginal) hysterectomy
what kind of procedure involves a vertical midline incision?
- laparotomy
what 2 procedures involve a supra-pubic incision?
- LSCS, abdominal hysterectomy
describe layers of anterolateral abdominal wall
- skin
- superficial fascia
- rectus sheath
- rectus abdomnis
laterally - external oblique muscle
- internal oblique muscle
- transversus abdominis
then reach internal lining of abdominal cavity
external obliques run in what kind of direction
- anteroinferior direction from ribs 5-12
- run in same direction as external intercostals
where do external oblique muscles attach between?
- lower ribs and iliac crest, pubic tubercle, and linea alba
at mid-clavicular line and spino-umbilical line (line between ASIS and umbilical area) turns into an aponeurosis and this is described as a
- flattened tendon
internal obliques run in the same direction as
- the internal intercostals (Opposite direction of external obliques)
internal obliques attach between where?
- lower ribs, thoracolumbar fascia, iliac crest and linea alba
fibres from external oblique blend in with what other fibres?
- internal obliques
transversus abdominis attach between where?
- between lower costal cartilages, thoracocolumbar fascia, iliac crest and linea alba
rectus abdomins lie between where
- 5-6th costal cartilages towards pubic symphysis
rectus abdominis divide into 3 or 4 smaller muscles by
- tendinous intersections
> why you have 6 pack/8 pack
within linea alba there is a defect called the
- umbilical ring
- fetal umbilical vessels pass here to reach placenta
how is linea alba formed?
- formed by interweaving of muscle aponeuroses
where is rectus sheath located
- immediately deep to superficial fascia
what is rectus sheath
- combined aponeuroses of anterolateral abdominal wall muscles
- surrounds rectus abdominis muscles (external oblique (anterior), internal oblique, transverse abdominis muscle and more centrally rectus abdominis)
what else runs through rectus sheath
- nerves and vessels
what is always contributing to anterior rectus sheath?
- external oblique muscles
below belly button describe rectus sheath
- anterior rectus sheath, as muscles all aponeurose anteriorly to rectis abdominis muscle
- does this about a 1/3 of the way between umbilicus and pubic crest
above belly button describe rectus sheath
- anterior and posterior rectus sheath
internal surface of abdominal wall
from most superficial
- tranversalis fascia
- layer of extra peritoneal fat
- parietal peritoneum (most internal)
once through this in peritoneal cavity and can access abdominal organs
nerves that supply anterolateral abdominal wall enter from what direction?
- lateral direction
- come from 7th to 11th intercostal nerves (intercostal space) and become thoracoabdominal nerves (abdominal wall)
> continuation
describe 3 other nerve supplies to anterolateral abdominal wall and where they arise from?
- subcostal (T12)
- iliohypogastric (L1)
- ilioinguinal (L1)
> these nerves supply both motor and sensory innervation to abdominal wall muscles
nervous supply to anterolateral abdominal wall is found where
- between internal oblique and transverse abdominis muscle
what supplies anterior abdominal wall
- superior epigastric arteries - continuation of internal thoracic
- emerges at superior aspect of abdominal wall
sup epigastric arteries anastomose just above umbilicus with what artery?
- inferior epigastric artery
> branch of external iliac arteries - emerges at inferior aspect of abdominal wall
what supplies lateral abdominal wall
- intercostal and subcostal arteries
> continuations of posterior intercostal arteries - emerge at lateral aspect
from about 12 weeks gestation what can be palpated on a pregnant women
- uterine fundus just above pubic symphysis
> grows about 1cm a week
incising muscle - what are 3 important things to consider?
- minimise traumatic injury to muscle fibres - incise in same direction in muscle
- avoid damaging nerves - particularly motor nerves
- avoid interrupting blood supply
LSCS incision - what layers are incised?
- skin and superficial fascia
- anterior rectus sheath
- rectus abdominis - these muscles are not cut - separated in a lateral direction
- fascia and peritoneum are then incised, ensure bladder is retracted
- uterine wall
- amniotic sac
what layers are stitched closed in LSCS incision?
- uterine wall w visceral peritoneum
- rectus sheath
- skin
laparotomy - what layers are opened?
- skin and fascia
- linea alba
- peritoneum
laparotomy - what layers are stiched closed?
- peritoneum and linea alba
- fascia
- skin
midline incision in laparotomy - what are complications?
- relatively bloodless area
> however this increases chance of wound complicationse.g. dehiscence, incisional hernia
laparoscopy - what kind of incision?
- sub-umbilical incision may be all that is required
- however if lateral port in required - care must be taken to avoid damaging inferior epigastric artery
laparoscopy - what can you do to enable view of pelvic organs
- position of uterus can be manipulated by grasping cervix w forceps inserted through vagina
avoiding inferior epigastric artery is particularly important in what procedure
- laparoscopy
inferior epigastric artery is a branch of?
- external iliac artery
- emerges just medial to deep inguinal ring/femoral pulse point (midway between ASIS and pubic tubercle)
inferior epigastric artery passes in what direction?
- superomedial direction post to rectus abdominis
- forms post aspect of inguinal triangle - site of direct inguinal hernias
what 2 ways can a hysterectomy be performed?
- abdominal - LSCS incision
- vaginal
during hysterectomy, extreme care must be taken to differentiate ureter from uterine artery - what direction does ureter pass in relation to artery?
- passes inferior to artery - water under the bridge
> ureter will often ‘vermiculate’ (wiggle) when touched
