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(no subject)From: Garry E. Siegel, M.D. (garrys@mindspring.com)Sat Aug 16 10:32:45 1997
I agree. Having done a few in residency, and a couple recently with some other docs, it is important to detach the muscle in the band of fascia (I guess it is the tendinious insertion) that attaches the muscle to the symphysis. This is so you can attach it back! Personally, having seen this twice recently, I'm not so sure about how well it really stays attached. When I want more room with a transverse skin incision, I will do a Maylard incision (transverse muscle splitting). For C sections, I was taught to do a "half-Maylard," where you open the fascia transversely a la Pfannienstiel, then do not dissect superiorly and inferiorly, but cut the muscle with the cutting Bovie for about 2/3 of the width, not going so far laterally as to get the inferior epigastrics. You then open the peritoneum transversely, also (stay high or you can amputate the dome of the bladder). This type of incision at a section does take a couple of extra minutes, but give much more room with a smaller skin incision. Furthermore, repeats are almost always a breeze. Credit goes to Professor Bruce A. Harris of the University of Alabama at Birmingham. Garry
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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