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Surgical Scars (Screenshot 2019-11-21 at 16.21.28 (Muscle splitting (Skin
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Surgical Scars
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Muscle splitting
- Skin
- Camper’s fascia
- Scarpa’s fascia
- External oblique
- Internal oblique
- Transversus
- Transversalis fascia
- Pre-peritoneal fat
- Peritoneum
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Limited access cf. midline incision
↓ damage to rectus
- segmental nerve supply means the muscle
can be cut transversely w/o weakening
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Rectus sheath opened and rectus displaced
laterally.
- Rectus slips back to cover the defect
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Midline Laparotomy
- Skin
- Camper’s fascia
- Scarpa’s fascia
- Linea alba
- Transversalis fascia
- Pre-peritoneal fat
- Peritoneum
Use
Elective
- Colectomy
- AAA
- Vascular bypass
Emergency
- Perforated DU
- Trauma
- Ruptured AAA
- Hartmann’s
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Closure: PDS, blunt J shaped suture, en mass
Jenkin’s Rule
- Length of suture = 4x length of incision
- 1cm bite, 1cm apart
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