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Cherney Incision
The Cherney incision is an incision used in gynecologic surgery. It is similar to the Pfannenstiel incision but allows access to the space of Retzius and gives a larger area in which to operate. __TOC__ Technique The Cherney incision begins when the skin is cut 2-3 centimeters above the pubic symphysis and the surgeon dissects down to the rectus abdominis muscle. The surgeon then uses blunt dissection with the fingers to separate the tendons from the overlying fascia before cutting the tendons 1-2 centimeters above the pubic symphysis. The muscles are then lifted away, toward the patient's head (cephalad). Then, the peritoneum can be cut and the surgery can proceed. Complications Complications can ensue. If surgical retractors are not placed carefully under the edges of the incision, they can damage the femoral nerve or other nerves in the area. If during wound closure, tendons are sewn directly to the pubic symphysis, osteitis pubis or osteomyelitis Osteomyelitis (OM) is a ...
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Surgical Incision
In surgery, a surgical incision is a cut made through the skin and soft tissue to facilitate an Surgery, operation or medical procedure, procedure. Often, multiple incisions are possible for an operation. In general, a surgical incision is made as small and unobtrusive as possible to facilitate safe and timely operating conditions. Anatomy Surgical incisions are planned based on the expected extent of exposure needed for the specific operation planned. Within each region of the body, several incisions are common. Head and neck * Wilde's incision – This post-aural incision is used for a variant mastoiditis drainage, and was named after Sir William Wilde, an Otolaryngology, ENT surgeon in Dublin who first described it at the end of the nineteenth century. His son, Oscar Wilde#Death, Oscar Wilde's, death was stated by his doctors to be due to meningitis stemming from an ear infection. He had recently had an operation, believed by some to be a mastoidectomy. Chest * Median sterno ...
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Pfannenstiel Incision
A Pfannenstiel incision , Kerr incision, Pfannenstiel-Kerr incision or pubic incision is a type of abdominal surgical incision that allows access to the abdomen. It is used for gynecologic and orthopedics surgeries, and it is the most common method for performing Caesarian sections today. This incision is also used in Stoppa approach for orthopedics surgeries to treat pelvic fractures. The Pfannenstiel incision offers a large view of the central pelvis but limits exposure to the lateral pelvis and upper abdomen, factors that limit the usefulness of this incision for gynecologic cancer surgery. This incision is commonly called the "bikini line incision". Some common reasons for this surgical access are obstetric delivery and hernia repair. It is often used in preference to other incision types for the sake of aesthetics, because the scar will be hidden by the pubic hair. The incision does not distort the belly button and heals faster than the traditional vertical incision. The ...
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Space Of Retzius
Retropubic space is a potential avascular space located between the pubic symphysis and the urinary bladder. The retropubic space is a preperitoneal space, located behind the transversalis fascia and in front of peritoneum . Other names for the retropubic space are "Cave of Retzius" or "Retzius' space", named after the Swedish anatomist Anders Retzius (1796-1860). The space is a useful landmark in different gynecological and urological surgeries. Structure The space is located in the pelvic region and is bounded by the following structures: *Anteriorly: Symphysis pubis *Laterally: Pubic rami and obturator internus muscles *Posteriorly: Urinary bladder *Floor: Anterior vagina (in women) and proximal urethra Function The retropubic space is a potential space. Compartmental Pressure The retropubic space is directly adjacent to the abdominal cavity and is hence affected with change in intra-abdominal pressure, which in turn affects the physiology of urination and continen ...
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Pubic Symphysis
The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubic symphysis. In females, the pubic symphysis is close to the clitoris. In most adults it can be moved roughly 2 mm and with 1 degree rotation. This increases for women at the time of childbirth. The name comes from the Greek word ''symphysis'', meaning 'growing together'. Structure The pubic symphysis is a nonsynovial amphiarthrodial joint. The width of the pubic symphysis at the front is 3–5 mm greater than its width at the back. This joint is connected by fibrocartilage and may contain a fluid-filled cavity; the center is avascular, possibly due to the nature of the compressive forces passing through this joint, which may lead to harmful vascular disease. The ends of both pubic bones are covered by a thin layer of hyaline ...
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Rectus Abdominis Muscle
The rectus abdominis muscle, ( la, straight abdominal) also known as the "abdominal muscle" or simply the "abs", is a paired straight muscle. It is a paired muscle, separated by a midline band of connective tissue called the linea alba. It extends from the pubic symphysis, pubic crest and pubic tubercle inferiorly, to the xiphoid process and costal cartilages of ribs V to VII superiorly. The proximal attachments are the pubic crest and the pubic symphysis. It attaches distally at the costal cartilages of ribs 5-7 and the xiphoid process of the sternum. The rectus abdominis muscle is contained in the rectus sheath, which consists of the aponeuroses of the lateral abdominal muscles. The outer, most lateral line, defining the rectus is the linea semilunaris. Bands of connective tissue traverse the rectus abdominis, separating it into distinct muscle bellies. In the abdomens of people with low body fat, these muscle bellies can be viewed externally. They can appear in sets of as f ...
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Peritoneum
The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesothelium supported by a thin layer of connective tissue. This peritoneal lining of the cavity supports many of the abdominal organs and serves as a conduit for their blood vessels, lymphatic vessels, and nerves. The abdominal cavity (the space bounded by the vertebrae, abdominal muscles, diaphragm, and pelvic floor) is different from the intraperitoneal space (located within the abdominal cavity but wrapped in peritoneum). The structures within the intraperitoneal space are called "intraperitoneal" (e.g., the stomach and intestines), the structures in the abdominal cavity that are located behind the intraperitoneal space are called "retroperitoneal" (e.g., the kidneys), and those structures below the intraperitoneal space are called "subp ...
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Surgical Retractors
A retractor is a surgical instrument used to separate and manipulate the edges of a surgical incision or wound, or to hold back underlying organs and tissues so that body parts underneath may be accessed. The broad term ''retractor'' typically describes a simple steel tool possessing a curved, hooked, or angled blade, which when in place helps to maintain the desired position of a given region of tissue during surgery. These simple retractors may be handheld, clamped in place, or suspended at the end of a robotic arm. Retractors can also be "self-retaining," and not need to be held once inserted, having two or more opposing blades or hooks which are separated via spring, ratchet, worm gear or other method. The term ''retractor'' is also used to describe distinct, hand-cranked devices such as rib spreaders (also known as thoracic retractors, or distractors) with which surgeons may forcefully drive tissues apart to obtain exposure. Different surgery specialties can have specific kin ...
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Femoral Nerve
The femoral nerve is a nerve in the thigh that supplies skin on the upper thigh and inner leg, and the muscles that extend the knee. Structure The femoral nerve is the major nerve supplying the anterior compartment of the thigh. It is the largest branch of the lumbar plexus, and arises from the dorsal divisions of the ventral rami of the second, third, and fourth lumbar nerves (L2, L3, and L4). The nerve enters Scarpa's triangle by passing beneath the inguinal ligament, just lateral to the femoral artery. In the thigh, the nerve lies in a groove between iliacus muscle and psoas major muscle, outside the femoral sheath, and lateral to the femoral artery. After a short course of about 4 cm in the thigh, the nerve is divided into anterior and posterior divisions, separated by lateral femoral circumflex artery. The branches are shown below: Muscular branches * The nerve to the pectineus muscle arises immediately above the inguinal ligament from the medial side of the femoral n ...
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Osteitis Pubis
Osteitis pubis is a noninfectious inflammation of the pubis symphysis (also known as the pubic symphysis, symphysis pubis, or symphysis pubica), causing varying degrees of lower abdominal and pelvic pain. Osteitis pubis was first described in patients who had undergone suprapubic surgery, and it remains a well-known complication of invasive procedures about the pelvis. It may also occur as an inflammatory process in athletes. The incidence and cause of osteitis pubis as an inflammatory process versus an infectious process continues to fuel debate among physicians when confronted by a patient who presents complaining of abdominal pain or pelvic pain and overlapping symptoms. It was first described in 1924. Signs and symptoms The symptoms of osteitis pubis can include loss of flexibility in the groin region, dull aching pain in the groin, or in more severe cases, a sharp stabbing pain when running, kicking, changing directions, or even during routine activities such as standing up ...
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Osteomyelitis
Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the feet, spine, and hips are most commonly involved in adults. The cause is usually a bacterial infection, but rarely can be a fungal infection. It may occur by spread from the blood or from surrounding tissue. Risks for developing osteomyelitis include diabetes, intravenous drug use, prior removal of the spleen, and trauma to the area. Diagnosis is typically suspected based on symptoms and basic laboratory tests as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).This is because plain radiographs are unremarkable in the first few days following acute infection. Diagnosis is further confirmed by blood tests, medical imaging, or bone biopsy. Treatment of bacterial osteomyelitis often involves both antimicrobials and sur ...
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Surgical Procedures And Techniques
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function, appearance, or to repair unwanted ruptured areas. The act of performing surgery may be called a surgical procedure, operation, or simply "surgery". In this context, the verb "operate" means to perform surgery. The adjective surgical means pertaining to surgery; e.g. surgical instruments or surgical nurse. The person or subject on which the surgery is performed can be a person or an animal. A surgeon is a person who practices surgery and a surgeon's assistant is a person who practices surgical assistance. A surgical team is made up of the surgeon, the surgeon's assistant, an anaesthetist, a circulating nurse and a surgical technologist. Surgery usually spa ...
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