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Re: type of incision? From: Raymond Stephen (Stephen.Raymond@dhhs.tas.gov.au) Thu Jul 31 01:15:08 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: verner nellsch: "Re: type of incision?" Previous message: Dr Eberhard W Lisse: "Re: type of incision?" In reply to: Gerald P. Rodríguez: "Fw: type of incision?" I debated about that, but it has been my experience recently that there are places where they have never heard of Trendelenburg, so I thought it wise to ensure clarity. Sorry if I assumed too much Steve Raymond Ph (03)62227898 Cell 0438372395 -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Gerald P. Rodríguez Sent: Thursday, 31 July 2008 12:53 PM To: Multiple recipients of list OB-GYN-L Subject: Fw: type of incision? 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 CONFIDENTIALITY NOTICE AND DISCLAIMER The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose. Next message: verner nellsch: "Re: type of incision?" Previous message: Dr Eberhard W Lisse: "Re: type of incision?" In reply to: Gerald P. Rodríguez: "Fw: type of incision?"

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