herrera4
Guru
Can anyone help with this note-confused when it comes to the flaps??
OPERATIVE FINDINGS: Included a large midline hernia with splaying to the rectus muscles for a distance of approximately 4 cm. After the mobilization of the subcutaneous tissue, the rectus muscles were apposed without tension. Mesh lay tightly against the rectus musculature.
DETAILS OF THE PROCEDURE: ...After appropriate time-out, midline incision was executed from xiphoid to the umbilicus. This was carried down through skin and subcutaneous tissue using cautery. The midline was quite attenuated. This was opened using cautery and this was opened to full extent using gentle blunt dissection to protect the underlying viscera using cautery. The fascial edges were visualized and it became apparent that the rectus muscles were splayed for a distance of 3 cm on either side. Skin flaps were elevated a distance of approximately 3 cm around the circumference of the wound and this included mobilization of the umbilicus where an umbilical hernia was also noted. Once the skin flaps were elevated, it became apparent that primary closure of the rectus muscles could be accomplished without undue tension and thus obviate the need for a component separation release. However, at this juncture, the posterior rectus sheath flaps were developed bilaterally. I incised the rectus sheath posteriorly near the attachment to the midline. This was carried widely to the lateral aspect of rectus musculature on both sides. Next, the two fascial flaps were approximated using a running 0 Vicryl. This tightened the posterior area quite nicely. A large sheet of Marlex mesh was then brought on the field. It was rinsed in Ancef solution and was tacked around the periphery in the retrorectus space to the rectus musculature using the secure strap tacker. This afforded excellent coverage posteriorly of the rectus musculature. The rectus muscles were then approximated in the midline without tension using interrupted figure-of-eight sutures of #1 Prolene. The muscles came together nicely without tension and the repair appeared to be quite solid. .......
thank you
OPERATIVE FINDINGS: Included a large midline hernia with splaying to the rectus muscles for a distance of approximately 4 cm. After the mobilization of the subcutaneous tissue, the rectus muscles were apposed without tension. Mesh lay tightly against the rectus musculature.
DETAILS OF THE PROCEDURE: ...After appropriate time-out, midline incision was executed from xiphoid to the umbilicus. This was carried down through skin and subcutaneous tissue using cautery. The midline was quite attenuated. This was opened using cautery and this was opened to full extent using gentle blunt dissection to protect the underlying viscera using cautery. The fascial edges were visualized and it became apparent that the rectus muscles were splayed for a distance of 3 cm on either side. Skin flaps were elevated a distance of approximately 3 cm around the circumference of the wound and this included mobilization of the umbilicus where an umbilical hernia was also noted. Once the skin flaps were elevated, it became apparent that primary closure of the rectus muscles could be accomplished without undue tension and thus obviate the need for a component separation release. However, at this juncture, the posterior rectus sheath flaps were developed bilaterally. I incised the rectus sheath posteriorly near the attachment to the midline. This was carried widely to the lateral aspect of rectus musculature on both sides. Next, the two fascial flaps were approximated using a running 0 Vicryl. This tightened the posterior area quite nicely. A large sheet of Marlex mesh was then brought on the field. It was rinsed in Ancef solution and was tacked around the periphery in the retrorectus space to the rectus musculature using the secure strap tacker. This afforded excellent coverage posteriorly of the rectus musculature. The rectus muscles were then approximated in the midline without tension using interrupted figure-of-eight sutures of #1 Prolene. The muscles came together nicely without tension and the repair appeared to be quite solid. .......
thank you
