Fw: type of incision?
From: Gerald P. Rodríguez (geraldpr@cybermesa.com)
Wed Jul 30 21:51:24 2008
What is going on here? We have someone, presumably intelligent, sending us
ignorant peasants the definition of the Trendelenburg position. Is this raw
pedantry or what!?
Gerald P. Rodríguez, M.D., FACOG
Santa Fe
>----- Original Message -----
From: "Raymond Stephen" <Stephen.Raymond@dhhs.tas.gov.au>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net>
Sent: Wednesday, July 30, 2008 6:44 PM
Subject: Re: type of incision?
> Start with some Trendelenburg (head down tilt). Perform a transverse
> incision just above the fold where the pannus reaches the mons. Make the
> rectus sheath incision wider than usual to compensate for the depth of the
> fat. Keep a heavy tissue forceps on the upper edge of rectus sheath and
> fix it in some way to retract constantly throughout the operation.
> Infection incidence is probably no different between midlines and
> transverses, but the potential consequences in a midline are much worse.
> I know of no evidence that proves that prophylactic antibiotics prevent
> wound infection, but it is likely. I don't think suture material has any
> bearing. Attention to minimising tissue trauma, bleeding, haematoma
> formation and tight bulky suturing are all good strategies.
>
> Steve Raymond
> Ph (03)62227898
> Cell 0438372395
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> rmodugno@aol.com
> Sent: Thursday, 31 July 2008 9:49 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: type of incision?
>
> -----Original Message-----
> From: Raymond Stephen <Stephen.Raymond@dhhs.tas.gov.au>
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
> Sent: Tue, 29 Jul 2008 9:35 am
> Subject: RE: OB didelphyic/bicornuate and breech --> type of incision?
>
> The best approach in an obese patient in
> obstetrics is the one that allows you to do what you have to do without
> postoperative risks. In my view that means avoiding a midline, because
> you only need access to the lower segment and sufficient width to
> deliver the
> baby.
>
> Steve Raymond
>
> Ph (03)62227898
>
> Cell 0438372395
>
> =================================
>
> Steve, I know physicians who use the same suture for transverse
> incisons and these patient types get infected no matter the abdominal
> approach.
>
> What is your approach to the obese patient with a large
> pannus/panniculus?
>
> Robert Modugno MD MBA FACOG
> Sylva, NC
