- PSA Question Pack: https://geekymedics.com/psa-question-bank/ Apply witch hazel pads to the perineal area. The incision is centred over McBurneys point two-thirds of the distance between the umbilicus and the right anterior superior iliac spine (ASIS), where the base of the appendix is most likely to be found. 10-6). B. This may help make the tissue more flexible. A. You can access our step-by-step guide alongside the video here: https://geekymedics.com/basic-life-support-bls-osce-guide/ Sometimes the incision is more extensive than a natural tear would have been. The incision can be extended beyond the lateral aspect of the rectus muscle if necessary to facilitate exposure. Superiorly, additional access can be obtained by directing the upper portion of the incision along the costal margin toward the xiphoid process (Fig. Although properly placed transverse incisions can provide exposure of specific organs, they may be limiting when pathology is located in both the upper and lower abdomen. B. Paramedian incision in transverse section. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Here, a guideline to the advantages and disadvantages of commonly used longitudinal and transverse incisions and the procedures for which they are best suited. Patients with benign gynecologic conditions also may benefit from a midline incision. Accessed Aug. 1, 2018. This wound can be opened and closed quickly and is of particular value in reopening a previous paramedian incision where dissection of the rectus muscle away from the rectus sheath can be difficult. The Lanz incision was designed to be more cosmetically subtle than the gridiron, with the benefit that it may be hidden beneath the bikini line but the disadvantage of commonly severing the ilioinguinal and iliohypogastric nerves. 1982;69:630.-, 10. If the peritoneum is inadvertently entered, it is closed immediately. Severe pain may need treated with stronger prescription medication, such as acetaminophen with codeine. Proponents of transverse incisions argue that they anticipate a more secure closure than with vertical incisionsa hypothesis supported by anatomic and surgical principle. Episiotomy risks Episiotomy recovery is uncomfortable. The muscles of the abdominal wall play a major role in supporting ventilation, forcing the diaphragm cephalad in order to increase intrathoracic pressure to aid expiration, and allowing it to contract into the abdomen to decrease pressure for inspiration. Disadvantages: prone to post-op wound dehiscence & herniation, slow access to abdominal cavity, lengthy closure, extreme post-op discomfort, hemorrhage and risk of nerve damage & post-op ischemia Applications for paramedian incision -Right upper paramedian: liver, gallbladder, biliary system, pancreas (head), duodenum

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