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scar painFrom: Belal Hossain (bhossain@doctor.com)Fri Mar 30 11:22:51 2001
I would like to draw attention from you regarding this problem.I have been practising ob/gyn since 1983.I use to open the abdomen by lower abdominal transverse incision (Pffnnensteil Incision) in nearly all cases.I use to cut the Rectus sheath transversely,then make a gap vertically by pulling rectus muscles laterally and open the peritoneum vertically.I use coated polyglactin for closure of Rectus sheath and atraumatic catgut for peritoneum closure.I didnot face any problem with this until recently;Yearwise on an average I perform nearly 150 cases of CS and nearly same no of laparotomies in my private clinic.Recently, few patients with transverse incision are complaining of some sort of unexplained pain over an area approx 1cm above the incision line.They also notice a linear swelling just over the cut line ,which clinically, in my opinion,bears no importance.Its some sort of a fold of fatty tissue.Unnoticingly one change has come in my habit.I use to incise the skin nearly just above the pubic hairline,then,bevelling the knife thru fatty lairs,I reach the rectus lair atleast1 cm up of the skin line.Though the number of patients are very few yet it is a matter of worry to my mental peace.Needless to say,the cases are not incisional hernias.Did you face the same problem in your practice life ever?I did not face the problem with the vertical incisions that I did in a very few cases.Is it due to the difference in the level of incision between skin and recti ?I am aware of the fact that few of us are not stiching up the peritoneum layer during closure. Dr B Hossain MD Group Practice Kolaghat India ______________________________________________ FREE Personalized Email at Mail.com -- ______________________________________________ Sign up at http://www.mail.com/?sr=signup
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