Principles of Abdominal Surgery Flashcards
what approaches can be used to enter the body wall?
- ventral midline
- paramedian
- flank
layers of the body wall
- skin
- subcutaenous
- body wall
- peritoneum
what is the most common way to enter the abdominal cavity?
ventral midline
ventral midline
- skin
- subcutaneous
- linea alba: holding layer!
- peritoneum
what is the holding layer for a ventral midline incision? why is this important?
linea alba! have to make sure it’s IN the closure, otherwise might get a hernia!
don’t want rapidly absorbing suture because it won’t stay long enough
paramedian layers
- skin
- subcutaneous
- external rectus sheath= holding layer
- rectus abdominus muscle
- internal rectus sheath
- peritoneum
what is the holding layer for a paramedian incision?
external rectus sheath, it is a little more vascular
pros vs cons of paramedian incisions
- pros: good to do something on one side: pylorus access, incisional gastropexy, etc
- cons: hard to get to other side and can’t see well
T/F: internal rectus sheath and peritoneum have no holding capacity
true
flank incision layers
- skin
- subcutaneous
- external abdominal oblique fasica- holding layer!
- external abdominal oblique musclce
- internal abdominal oblique muscle
- transverse abdominus muscle
- peritoneum
***what is the holding layer for a ventral midline incision?
linea alba!
** what is the holding layer for a paramedian incision?
external rectus sheath
** what is the holding layer for a flank/paralumbar incision?
external abdominal oblique FASCIA!!!
what are the ideal sutures for body wall closure
absorbable (long lasting), and monofilament
what suture is the strongest at the beginning?
biosyn!
what suture loses its strength very quickly
monocryl
what suture is ideal for bladder?
monocryl
when should you use a surgeon’s throw in the abdomen?
only when tension requires it
what is the best suture pattern for abdominal closures?
APPOSITIONAL!
- simple interrupted
- simple continuous- common
- cruciate - use with unhealthy tissue
- near far far near
what are the appositional suture patterns used for abdominal surgery?
- simple interrupted
- simple continuous
- cruciate
- near far far near
can you use everting sutures in abdominal surgery?
yes, but rare
what are the everting sutures?
vertical mattress
horizontal mattress
why not to use interrupted in abdominal surgery?
- time
- foreign material
- security
when do you use near far far near in abdominal surgery?
if there is expected tension
T/F: mattresses are good sutures to use in abdominal surgery if there is damaged/dead tissue
FALSE stay away from mattresses; want to avoid everting!
where should you put your largest suture in abdominal surgery?
holding layer!
where should you put your smallest suture in body wall closures?
subcutaneous to close dead space
