Week 4 - Anatomy of Surgical Incisions Flashcards
A vertical midline incision is most likely to be used for what procedure?
Laparotomy
A suprapubic incision is most likely to be used for which procedures?
Lower segment C-section or abdominal hysterectomy
A subumbilical incision is most likely to be used for what procedure? What may also be seen alongside this incision?
Laparoscopy / lateral port sites
The direction of cut for a surgical incision should ideally follow what if possible?
Langer lines
What are the layers of the lateral aspect of the anterolateral abdominal wall from outer to inner?
Skin, superficial fascia, external oblique, internal oblique, transversus abdominus
What are the layers of the anterior aspect of the anterolateral abdominal wall from outer to inner?
Skin, superficial fascia, rectus sheath, rectus abdominus
The external oblique muscle attaches between where?
The lower ribs and the iliac crest/pubic tubercle/linea alba
What is the linea alba?
A midline blending of aponeuroses
Fibres of the external oblique muscles run in the same direction as what?
External intercostal muscles
The internal oblique muscles attach between where?
The lower ribs, thoracolumbar fascia, iliac crest and the linea alba
Fibres of the internal oblique muscles run in the same direction as what?
Internal intercostal muscles
The transversus abdominus muscles attach between where?
The lower ribs, thoracolumbar fascia, iliac crest and the linea alba
Which anterolateral abdominal wall muscle has tendinous intersections?
Rectus abdominus
What is the function of the tendinous intersections of the rectus abdominus muscle?
Divides it into smaller muscles for improved mechanical efficiency
The linea alba runs from where to where?
Xiphoid process of the sternum to the pubic symphysis
What is the significance of stitching closed the rectus sheath after an operation?
Improves wound healing and reduces the risk of wound complications
The rectus sheath is found immediately deep to what?
The superficial fascia
What is the rectus sheath?
A combined aponeurosis of the anterolateral abdominal wall muscles
The rectus sheath surrounds which structure?
The rectus abdominus muscle
When undertaking a suprapubic incision, only which aspect of the rectus sheath is cut?
Anterior rectus sheath
The nerve supply to the anterolateral abdominal wall enters in what direction?
Lateral
What are the main nerve supplies to the anterolateral abdominal wall?
7th-11th intercostal nerves (as the thoracoabdominal nerves), subcostal nerves, ilioinguinal and iliohypogastric nerves
Where do the nerves supplying the anterolateral abdominal wall travel between?
The plane between the internal obliques and transversus abdominus’
What are the 2 arteries supplying blood to the anterior abdominal wall?
Superior and inferior epigastric arteries
The superior epigastric arteries are a continuation of what arteries?
Internal thoracic arteries
Which arteries supplying the anterior abdominal wall emerges at its superior aspects?
Superior epigastric arteries
Where do the superior and inferior epigastric arteries lie?
Posterior to the rectus abdominus
The inferior epigastric arteries are a branch of what?
External iliac arteries
Which arteries supplying the anterior abdominal wall emerges at its inferior aspects?
Inferior epigastric arteries
Which arteries supply blood to the lateral abdominal wall?
Intercostal and subcostal arteries
Intercostal and subcostal arteries are continuations of what?
Posterior intercostal arteries
When incising muscle, what is the best way to minimise traumatic injury to the muscle fibres?
Incise in the same direction as muscle fibres
What happens to the rectus muscles in a LSCS?
They are not cut, they are separated from each other in a lateral direction
A vertical midline incision is relatively bloodless - what is the significance of this?
Can mean that healing is not as good and increases the chance of wound complications
If a lateral port is required for a laparoscopy, care must be taken to avoid which structure?
Inferior epigastric artery
Where does the inferior epigastric artery arise?
Just medial to the deep inguinal ring
From its emergence just medial to the deep inguinal ring, in which direction does the inferior epigastric artery travel to reach the rectus abdominus?
Superomedial
How can the pelvic organs be viewed during laparoscopy?
By manipulating the position of the uterus by grasping the cervix with forceps inserted through the vagina
During a hysterectomy, extreme care must be taken to differentiate what two structures?
Ureter and uterine artery
How can you tell the difference between the ureter and the uterine artery?
The ureter passes inferior to the artery / the ureter will vermiculate when touched
