Operative note 06 Core
Open incisions to know
What it does: the standard cuts, and how to open each.
- Midline: skin, fat, linea alba. Find the midline via the urachus. (Urachus = fetal tube, bladder dome to umbilicus.) Finger in the wound top, pull up. A ridge rises. Cut on the ridge.
- Peritoneum: 2 clips, pinch, no bowel, cut between. Enlarge with scissors between 2 fingers.
- Pfannenstiel: curved cut 2 cm above the pubis. Open sheath in the same curve. Sweep sheath off both recti, up and down. Separate the recti in the middle. Do not cut them. Cut the recti off the pubis = Cherny. Rarely needed.
- Loin, over the 12th rib: cut onto the rib tip. 3 cm diathermy through latissimus dorsi. Then cut in front of the rib tip, through the obliques, onto Gerota's fascia. (Gerota's = the kidney's fascia wrapper.) Sweep the peritoneum inwards with a finger. Cut muscle along the rib, centrally. Avoid the pleura.
From the UroRef Operative Quick Guide.