Abdominal Wall Incision - Muscle Splitting
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Abdominal Cavity Approach
The anatomical landmarks that are used in this procedure are the umbilicus and the anterior superior iliac spine. The skin incision is made obliquely in the Langer’s skin lines at McBurney’s point; two thirds of the way of the umbilicus to the anterior superior iliac spine. The incision is approximately 5 cm long. For cosmetic reasons a more lower and lateral incision can be made. Retract the skin with sharp retractors. The subcutaneous tissue is seperated with electrocautery until the aponeurosis of the external oblique muscle is reached.Incise the aponeurosis of the external oblique muscle along the direction of its fibers. The subcutis, the aponeurosis of the external oblique muscle. Split the external and underlying internal oblique muscles and transverse abdominal muscle parallel to its fibers with two dissection forceps. Hold the muscles aside with retractors. Peritoneum with overlying peritoneal fat. Lift the peritoneum with forceps and postpone cutting the peritoneum until the silversign is seen. Here you see the silversign as a reflection of the scissor blade through the peritoneum. This manoeuvre can also be done with a finger. Using this manoeuvre the risk of perforating intraperitoneal organs is reduced.
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