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The vena cava is exposed on the right, and the aorta is exposed on the left. Apply witch hazel pads to the perineal area. It is often useful to resect a short segment of costal cartilage to facilitate closure of the chest wall. Episiotomy: Procedure and repair techniques. The diaphragm is either incised radially toward the esophageal or aortic hiatus or in a curvilinear fashion if less exposure is required. The skin incision may be shorter than depicted in thinner patients or if an abscess is to be drained. what are the advantages and disadvantages of a transverse incision? Midline or transverse laparotomy? Disadvantages Big Scar Very painful post-op Higher risk of wound breakdown Uses Emergency lapartotomy Almost all abdominal operations where full access is required Paramedian incision Uses Access to specific half of abdomen Advantages Access to lateral structures E.g. The theoretical advantage of a paramedian over a midline incision is a diminished risk of wound dehiscence and incisional hernia owing to the presence of rectus muscle interposed between layers of divided fascia. DO NOT perform any examination or procedure on patients based purely on the content of these videos. surgical technique, site and orientation of incision, intra-operative contamination, lengthy procedure). DO NOT perform any examination or procedure on patients based purely on the content of these videos. Hendrix SL, Schimp V, Martin J. Epigastric midline incision: surface markings. Use an over-the-counter (OTC) pain reliever like acetaminophen or ibuprofen as recommended by your provider. The incidence and nature of complications will be influenced by the patients comorbidities. An elastic defect in this raphe may allow the fascia to stretch and abdominal contents to bulge forward through the resulting divarication of the recti. One randomized controlled trial compared vertical and transverse incisions with regard to the frequency of evisceration; no significant difference in outcome was observed with either technique.2 In a more recent prospective randomized trial, no significant differences in 30-day mortality, pulmonary complications, median length of hospital stay, median time to tolerate solid food, and incisional hernia formation at 1 year were observed. This incision is oriented obliquely. The recti are interrupted by three paired tendinous intersections anchoring them to the anterior sheath, broadly found close to the xiphisternum, at the level of the umbilicus and then halfway between the two. The medial aspect of the anterior rectus sheath is then dissected away from the rectus muscle to its medial edge (Fig. . 10-2). Here,a guideline to the advantages and disadvantages of commonly used longitudinaland transverse incisions and the procedures for which they are best suited. Retroperitoneal and extraperitoneal approaches can be used for operations on the kidney, ureter, adrenal gland, bladder, splenic artery and vein, vena cava, lumbar sympathetic chain, abdominal aorta, and iliac vessels, and on groin hernias. Once the underlying transversalis muscle is exposed, it is split to reveal the transversalis fascia and peritoneum. MDedge: Keeping You Informed. The use of chlorhexidine gluconate has been associated with greater reductions in skin bacterial counts and lower rates of surgical site infection when compared to povidone-iodine in a number of studies8-11 and is emerging as the preferred skin antiseptic. Exposure can be optimized with judicious use of a flexible retractor system. This may help make the tissue more flexible. The peritoneum has been bluntly dissected from the retroperitoneal structures with the preperitoneal fat and soft tissue. Some people line their sanitary pads with witch hazel pads for extra relief. Pfannenstiel Incision - an overview | ScienceDirect Topics Your obstetrician uses a local anesthetic (typically injected into the area) to numb your perineal area so you don't feel pain.