TOG: Abdominal incisions and sutures in O&G

Question 1

what is the description of the pfannenstiel incision?

Answer 1

curved incision. 10-15cm long. 2cm above pubic symphysis. SKin and rectus sheath opened transversely using sharp dissection. Fascia dissected along rectus muscles.

Question 2

what is the Kustner incision? which blood vessels may be injured during this incision?

Answer 2

curved incision. Begins just below level of ASIS and extending just below pubic hairline. superficial branches of inferior epigastric artery/vein may be damaged.

Question 3

what is the Cherney incsion? when might it be used?

Answer 3

transection of rectus muscles at their insertion on pubic symphysis and retracted cephalad to improve exposure. used for urinary incontinence proccedures to expose space of Retzuis and exposeure to sidewalls

Question 4

what is the Joel-Cohen incision?

Answer 4

straight transverse incision through skin. 3cm below level of ASIS. subcut tissues and fascia opened with blunt dissection. Blunt dissection used to separate rectus muscles and open peritoneum.

Question 5

what are the advantages of transverse incision?

Answer 5

best cosmetic result, less painful, greater strength

Question 6

what are the advantages of vertical incision?

Answer 6

excellent exposure, easily extendible, median incision is least haemorrhagic, minimum nerve damage, rapid entry to abdomen

Question 7

what are the disadvantages of vertical incision?

Answer 7

wound dehiscence and hernia more frequent, poorer cosmetic result, higher infection & haemorrhage rates & operative time with paramedian incision

Question 8

why is the Joel-Cohens incision found to be superior to pfannenstiel incision?

Answer 8

less post-op febrile morbidity
less analgesia requirements
shorter operating time,
less intraoperative bloodloss
less adhesion formation

Question 9

what is the fascial dehiscence rate with running mass closure of the abdomen?

Answer 9

0.4%

Question 10

what is the ideal suture for mass closure technique?

Answer 10

looped delayed-absorbable suture with wound:suture length ration of at least 1:4. Subcut tissues should be avoided

Question 11

what is the Gallup closure technique?

Answer 11

Closure of midline incisions using No.2 polypropylene suture placing bites 1.5-2cm from fascial edge. It includes all layers of abdominal wall (peritoneum, fascial layers, muscle). One suture started at either end and meet in the middle with 3 square knots.

Question 12

by how much does wound infection increase in morbid obesity?

Answer 12

seven fold increase

Question 13

when is deep sheath closure required in laparoscopic surgery?

Answer 13

any non-midline port >7mm and any midline port >10mm. To avoid port site hernia

Question 14

what is polyglactin and is it braided?

Answer 14

vicryl. braided

Question 15

What is polyglactiC?

Answer 15

vicrylRapide. Monofilament

Question 16

which absorbable suture provides the greatest tensile strength?

Answer 16

polydioxanone (PDS)

Question 17

which non-absorbable suture gives the least tissue reaction?

Answer 17

polypropylene (prolene)

Question 18

how long does polyglactic (vicrylRapide) take to absorb?

Answer 18

7-14 days

Question 19

How long does polyglactin (vicryl) take to absorb?

Answer 19

60-90 days

Question 20

how long does polyglecaprone (monocryl) take to absorb?

Answer 20

90-120

Question 21

what are the advantages of using adhesives/ glue?

Answer 21

faster, no need for suture removal.

cyanocrylates (synthetic glue) have been shown to have antimicrobial properties (esp againsy gram +ves)

Question 22

which of the absorbable sutures take the longest to absorb?

Answer 22

polydioxanone (PDS), polytrimethylene carbonate (Maxon) . Both take 180-210 days to absorb

Question 23

what are the advantages of using staples for closing wounds?

Answer 23

low tissue reactivity.
highest tensile strength of any wound closure material.
contaminated wounds closed with staples have lower incidence of infection compared with those closed with sutures