Page 1 of 2: churgery!

akanksha · Credits: 41247 My Scrapbook My Reading List 14 Books

so heres another one frm my ever growing bank of confusion!

A patient was operated 2 months back and at that time a midline incision was used.Now he requires a second operation and the ideal incision to be used now is-
a)a fresh transverse incision.
b)the scar of the previous incision is excised and the same incision is used.
c)the same incision is used without excision of the old scar.
d)a paramedian incision is to b used.

now what i ve learnt frm my clinics(& of course managed to remember also!) is dat linea nigra takes arnd 6 months for remodelling.so if this is a contraindication(sort of) to operate on the same scar(jus to not interfere with the remodelling process n make the pt go for an incis. hernia later),then the choice def wud be the transverse inc.

also dat he being operated for the 2nd time & appreciating adhesions(but will significant amt. of adhesions develop in a period of 2 months?),agn transverse incision cums in mind.

i ve got another point to say why shd we use the previous incision,but then all these together will make u as confused as myself.

so tell me wat incsn u wud go in for!

doctorgirl78 · Credits: 5396 My Scrapbook

dont worry aku baby,its a good sign that you are using your brains........
could you really make a huge favour..........always include the reference from where you picked up the Q unless its Ab pvt. ltd. by product

for the answer.i confess never been good at surgery........

akanksha · Credits: 41247 My Scrapbook My Reading List 14 Books

doc saab,wo kya hai na ki, if all the 'SETTERS' wud hav wanted sum readymade questions, AB pvt ltd wud hav always tried to help with sum original n of course mindblowing stuff! 8)

but the prob is AB pvt ltd isnt dat famous.

this Q was asked in NIMHANS 2002.(sorry for this omission;i always forget to add the SOURCE of confusion creator!shall take care frm now onwards.)

akanksha · Credits: 41247 My Scrapbook My Reading List 14 Books

KOI HAI helllloooooooooo........!

RxPG,bruno,doc(g) and all of u there.......
wont u answer this one?

please!

Bruno · Credits: 44755 My Scrapbook My Reading List 50 Books

akanksha · Credits: 41247 My Scrapbook My Reading List 14 Books

yup,Bruno u're right to say dat an incision made on healing scar wud heal faster.

but don u think dat paramedian & midline incision are essentially the same,when the area of field work is considered,as well as approach!

midline is gud bcos,u can open fast(thus used for emergencies) as u've to go thru jus three layers viz,the skin,line alba & fascia tranversalis with peritoneum.exposure is good and also as relatively avascular area of abd is cut,bleeding is less.all these makes it siutable for emergency surgeries.

and in paramedian,the diff is dat its timeconsuming(as max time goes off dividing the tendinous intersections of the rectus muscle,& retracting the muscle laterally).also dat this adds to the advantage in wound healing,as u've supported u're peritoneal sutures with intact rectus muscle above it,while closing.
this helps in an efficient wound healing(as rectus muscle is vascular and linea alba is not). 8)

so the main diff b/w these two procedures is actually in the way of opening & the resultant wound after closing. the entire effect DURING the surgery is almost the same.nahin?

while transverse incision has still the advantage of better exposure ,faster healing,and also dat its along langs lines.

but cosmetically i wont discuss much as if i put a transverse incision on this pt now,his abdomen wud appear a cross bun.

all these points r taken frm operative surgery by das.but nowhere is the ans to this question given.

dunno how far our logics goin to work.

pacemaker · Credits: 101 My Scrapbook

Every thing is clear.

1>incision made on healing scar wud heal faster.
2>Midline scar is good

So here surgery was done 2 months back. So the scar is in healing progress OK
Now we can simply remove the previous scar to make it a clear cut injury . Do the surgery and stich again.
So ans>the scar of the previous incision is excised and the same incision is used.
This is my surgury brain says to me....

doctorgirl · Credits: 420 My Scrapbook

from what i remember from my surgery,Anaesthesia and Gynae OT rotations ..........take my word for it.......I ATTENDED THEM RELIGIOUSLY
i remember the surgeons cutting out the old scar and using the same midline incision ........i even checked out with the neighbouring nursing home doubling up as Obs OT.......all the surgeons there unanimously said they would excise the old scar and use the same incision.......

ya its not as solid a reference as i always insist for but if i get the Q i'll go for it................

docind · Credits: 1486 My Scrapbook

hi akanksha,

Its b)the scar of the previous incision is excised and the same incision is used

from my clinical exp !!!!

from my surgery internship...i remember

any way i dint get the correct reference !!

docind · Credits: 1486 My Scrapbook

hi akanksha,

Its b)the scar of the previous incision is excised and the same incision is used

from my clinical exp !!!!

from my surgery internship...i remember

any way i dint get the correct reference !!

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