Re: type of incision?
From: Dr Eberhard W Lisse (el@lisse.na)
Thu Jul 31 00:50:14 2008
No, it is to assist Shabanay Nellsch with looking up the definition.
el
On 31 Jul 2008, at 03:51 , Gerald P. Rodríguez wrote:
> 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
>
