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Checklist for Abdominal Incisions

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This checklist is part of the Gynsurgery guidelines used in an educational setting for residents in Ob-Gyn.

Preoperative Checklist

The pdf form of the Abdominal Incision Checklist may not contain the latest changes

 (Please indicate    -   Done,   X - Not done,   NA – Not applicable)
  1. ____ Inform patient of wound complications and their likelihood of occurrence (wound infection, hematoma, dehiscence, pain, cosmetic changes) along with complications of the primary procedures being performed (prevent incorrect expectations)
  2. ____ If at high risk for wound dehiscence and infection, smoking, obesity, history of radiation therapy, diabetes, arteriosclerosis, steroid use, depressed immune system:
    1. ____counsel about increased wound complications (prevent incorrect expectations)
  3. ____ If diabetic:
    1. ____make sure blood sugars are in optimal control (prevent infection)
  4. ____ If currently smoking:
    1. ____ Advise to discontinue smoking as far prior to procedure as possible (prevent infection, dehiscence)
  5. ____Choose type of incision most likely to be used (promote correct expectations)
  6. ____Advise to cleanse incision site prior to procedure with antibacterial soap (prevent infection)
  7. ____Advise patient may clip hair evening prior to surgery but no shaving (prevent infection)
  8. ____Advise patient about postoperative care including to minimize valsalva with rising from a chair, getting out of bed etc., (prevent dehiscence)
  9. ____Keep good glycemic control if a diabetic (prevent infection)


Intra operative Checklist

  1. Abdominal wall incision
    1. ____ Identify midline and anterior iliac spine and mark on skin the line of the incision if needed (prevent asymmetry of incision)
    2. ____ Cut skin incision and subcutaneous tissue with knife, not cautery, and avoid excessive cautery ) (prevent wound infection)
    3. ____ Start transverse incision at least 3-5 cm above symphysis pubis (prevent nerve transection)
    4. ____ Follow lines of Langer, curving transverse skin incision upward laterally so as not to transect cutaneous nerves (prevent nerve transection)
    5. ____ If removing old scar:
      1. ____excise subcutaneous tissue symmetrically (prevent poor cosmetic scar result)
    6. ____Cut rectus fascia only to edge of rectus muscle, avoid lateral extension of incision into internal oblique muscle (prevent nerve transection)
    7. ____Cauterize or ligate superficial epigastric vessels on transverse incision even if not bleeding at time of transection (prevent post operative bleeding)
    8. ____Cauterize or ligate rectus perforating vessels on Pfannenstiel incision even if not bleeding at time of transection (prevent post operative bleeding)
    9. ____ Avoid cutting fascia with cautery or cauterizing large areas of fascia (prevent fasical dehiscence)
    10. If midline incision:
      1. ____if incision is extended above the umbilicus, extend around the left of the umbilicus to avoid the ligamentum terres (prevent post operative bleeding)
      2. ____ On midline incisions close peritoneum with fascia through the rectus sheath using continuous delayed absorbable or permanent suture (prevent wound dehiscence)
    11. If Maylard incision
      1. ____ Ligate inferior epigastic vessels on Maylard incision (prevent post operative bleeding)
  2. Peritoneal management
    1. ____ Enter abdominal peritoneum as cephalad to the fascial incision as possible (prevent bladder injury)
    2. ____ Avoid lateral retraction compressing psoas muscle (prevent femoral, genitofemoral and lateral cutaneous femoral nerve injury)
    3. ____ On Pfannenstiel or Maylard incisions, close or approximate abdominal peritoneum as a separate layer. (prevent wound dehiscence)
  3. Closing abdomen
    1. ____ Observe subfascial space before closing fascia for bleeding (prevent hematoma)
    2. ____ Place fascial sutures approximately 1.0 cm from edge of fascia and approximately 1.0 cm apart (prevent wound dehiscence)
    3. ____ When closing anterior rectus fascia avoid subcutaneous tissue (prevent nerve entrapment)
    4. ____ Approximate fascia without tension on sutures (prevent wound dehiscence)
    5. ____ On transverse incisions, reapproximate Scarpa’s fascia superiorly to Scarpa’s fascia inferiorly and Camper’s to Camper’s if present (prevent poor cosmetic scar result)
    6. ____ Close subcutaneous tissue with running continuous absorbable suture if 2.0 cm of subcutaneous fat or more (prevent wound infection)
    7. ____ Use a hypo allergenic skin adhesive rather than benzoin (prevent poor cosmetic scar result)
    8. ____ Close skin with steristrips or bonding (prevent poor cosmetic scar result)
    9. ____ Avoid skin staples or if used, remove by 3rd day (decrease postoperative incisional pain) (prevent poor cosmetic scar result)
    10. ____Use compression dressing for 48 hours before removing (prevent wound hematoma)

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