Re: type of incision?
From: verner nellsch (vnellsch@eastex.net)
Thu Jul 31 05:39:50 2008
eberhard,
what a classy guy you are.
one usually has to go to a bowling alley to meet someone of your stature.
the butler in arthur.
vnellsch.
>----- Original Message -----
From: "Dr Eberhard W Lisse" <el@lisse.na>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net>
Sent: Thursday, July 31, 2008 12:52 AM
Subject: Re: type of incision?
> 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
>>
>
