Use of this Web site is subject to the medical disclaimer. The relative merits and disadvantages of vertical versus transverse incisions remain subjects of active debate. Immediate complications of a midline laparotomy incision may include anaesthetic difficulties, haemodynamic instability, primary haemorrhage from cut vessels and iatrogenic injury to surrounding tissues and viscera. When possible, and particularly in high-risk patients in which wound healing may be compromised, reducing the incision . Labor & Delivery: Types of Episiotomies - Healthline Cleveland Clinic is a non-profit academic medical center. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Abdominal Incisions Diagram | Quizlet - PSA Question Pack: https://geekymedics.com/psa-question-bank/ All rights reserved. Check out our other awesome clinical skills resources including: Chapters: Samml Klin Vortr (Leipzig). Episiotomy: When it's needed, when it's not - Mayo Clinic You can expect some pain and soreness once the anesthesia wears off. A left thoracoabdominal incision is useful for access to the left hemidiaphragm, gastroesophageal junction, gastric cardia and stomach, distal pancreas and spleen, left kidney and adrenal gland, and aorta. F. The peritoneum is incised for the full length of the wound. 3. The rectus sheath may be considered as having three distinct sections: 1. information is beneficial, we may combine your email and website usage information with Advertising revenue supports our not-for-profit mission. The avascular linea alba affords the vertical midline its superior flexibility. Put warm water in a "peri bottle" and squirt your perineal area when using the bathroom or changing your absorbent pad. Can vaginal tears during childbirth be prevented? II. Close proximity of a new incision to an old one should be avoided in order to minimize the risk of ischemic necrosis of intervening skin and fascial bridges. Donaldson DR, Hegarty JH, Brennan TG, et al. As the recti have a segmental nerve supply, it can be cut transversely without weakening a denervated . The longitudinal incisions that will be reviewed here are the midline (median) and paramedian. Surface markings of the right iliac fossa appendectomy incisions. L- or J-shaped incisions were first described by Masatoshi Makuuchi and have gained considerable popularity for upper abdominal surgery and liver resection in particular.14 These incisions, which extend from xiphoid to the umbilicus and across the right or left hemirectus in transverse fashion, have several theoretical and real advantages. TikTok: https://www.tiktok.com/@geekymedics Midline or transverse laparotomy? The skin incision may be shorter than depicted in thinner patients or if an abscess is to be drained. Carbon dioxide (CO2) is insufflated into the abdomen to a pressure of 12 to 15 mm Hg. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Significant disadvantages of this incision include the limited exposure afforded, the inability to visualize the posterior hilar structures, and the frequent sacrifice of the internal thoracic vessels. This video demonstrates how to use an automated external defibrillator (AED) in the context of cardiopulmonary resuscitation (CPR). Use an over-the-counter (OTC) pain reliever like acetaminophen or ibuprofen as recommended by your provider. This can be achieved using an open or closed technique. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ 10-11). Moreover, by combining vertical and transverse components, an abdominal wall flap is created that can be retracted superiorly yielding wide exposure without division of both sides of the rectus. If exposure of both the upper and lower peritoneal cavities is required, the incision is carried around the umbilicus in a curvilinear fashion. An advantage of this incision is that it affords a cosmetic closure because it is placed in a skin crease at the level of the belt line; however, exposure may be somewhat limited. Disadvantages include the risk of injuring the superior epigastric vessels, and lateral extension of the incision risks disruption of intercostal nerves. Any stitches used to repair the episiotomy are usually absorbed on their own. The McBurney incision has largely been supplanted by the Rockey-Davis incision, which is oriented transversely as opposed to obliquely, allowing for better cosmesis (Fig. MDedge: Keeping You Informed. . Episiotomy is a procedure in which your obstetrician makes a small cut between the bottom of your vaginal opening and anus (an area called the perineum) during childbirth. Common examples include the Kocher subcostal incision for biliary surgery, the Pfannenstiel infraumbilical incision for gynecologic surgery, and the McBurney and Rocky-Davis incisions for appendectomy. Risk factors for wound dehiscence can be: Late complications include the development of an incisional hernia, where the underlying peritoneum and associated contents protrude through residual defects in the abdominal wall, and the formation of dense fibrotic intra-abdominal band adhesions. Ellis H, Coleridge-Smith PD, Joyce AD. The medial aspect of this incision will be through the layers just like as in the midline incision. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. The midline incision provides excellent exposure to all areas of the abdomen and retroperitoneum, which can be accessed with minimal risk of significant vascular or nerve injury. Cause the least amount of damage. Sanders RJ, DiClementi D. Principles of abdominal wound closure. 2001;88(1):41-44. Use of the Pfannenstiel incision, which marries a cosmetically acceptable low transverse abdominal incision with a vertical midline fascial incision, also presumes that the scope of the pathology has been accurately assessed prior to surgery.If more exposure is required because this is not so, the surgeon's ability to make the incision larger is limited. It is an excellent choice when access to the upper abdomen may be necessary, e.g., patients with gynecologic malignancies who may need assessment of the diaphragm, liver biopsy, para-aortic node biopsy, omentectomy, or debulking procedures. The lateral paramedian incision-experience with 850 cases. Exposure of the fascia is often enhanced with the use of S-shaped retractors. Incisions through the anterolateral wall will, therefore, breach the following structures: As the fibres of the lateral abdominal wall muscles progress medially they give rise to fibrous sheets of tissue known as aponeuroses, allowing a far wider area of insertion than would be achievable with the typically round tendons seen on muscles of the appendicular skeleton. This approach is commonly used for procedures requiring emergency laparotomy, such as in faecal peritonitis secondary to malignant intestinal perforation or in cases of ischaemic bowel. A midline incision is easier to repair, but it has a higher risk of extending into the anal area. The incision should be considered as a second surgical procedure, which temporarily interferes with normal abdominal wall function. You're exhausted and dehydrated from prolonged labor. Terms in this set (32) What is a ventral midline incision, and when is it used? A midline episiotomy puts you at risk of fourth-degree vaginal tearing. Transverse and oblique incisions generally follow Langers lines of tension and allow a more cosmetic closure than do vertical incisions. In reality, the incision is a second surgical procedure, which interferesat least temporarilywith normal abdominal wall function. The thoracoabdominal incision provides enhanced exposure of upper abdominal organs. (Reproduced with permission from Baker RJ, Fischer JE: Mastery of Surgery, 4th ed. The recti are retracted laterally and the peritoneum is opened vertically in the midline. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). 10-1). A multicenter collaborative study on the use of cold scalpel and electrocautery for midline abdominal incision. While most physicians concur that the essential elements of a well-planned incision include adequate access to anticipated pathology, extensibility, and security of closure, many may not consider preservation of abdominal wall function as a key factor in their decision-making.