Abdominal Operations Seventh Edition Volume One

Abdominal Operations Seventh Edition Volume One, Rodney Maingot, 63336, Appleton Century Crofts, Eğitim Kitapları, Kişisel Gelişim, Yabancı Dilde Kitaplar

SECTION I ABDOMINAL INCISIONS AND EXPLORATORY LAPAROTOMY 1 DESCRIPTIONS OF INDIVIDUAL INCISIONS SUTURE MATERIALS; THE MAKING AND CLOSING OF ABDOMINAL INCISIONS CLOSURE OF ABDOMINAL WALL RODNEY MAINGOT Never judge the surgeon until you huve him close the wound-MOYNIHAN INTRODUCTION edge that the expert surgeon has acquired by It is probably no exaggeration to stale that ieperience. For example, in certain types of pa abdominal surgery wisely chosen incisions and ins, such as the aged, the obese, the cachectic, correct methods of making and closing such and those suffering from destructive lesions of wounds are factors of paramount importance the gastrointestinal tract-including cancer of Any mistakes here, such as a badly placed inci the stomach and colon, acute peritonitis, congen sion, careless disregard of the motor nerves that ital lesions of the intestines in infancy, etc.- supply the abdominal muscles, inept methods the recognised routine methods of incision and of suturing, ill-judged selection of suture mate- closure of the abdominal wall may not be appli- rial, or failure to protect the wound from con- cable, and the success of the particular opera tamination during the conduct of the operation, tion will in no small measure depend on the may result in serious immediate or later compli length of the incision and judicious placing of cations such as haematoma formation, infection the incision and on wise selection of suture ma- by pyogenic organisms, disruption of the wound, terial and method of closure to be adopted. This stitch abscess, a weakened scar, an ugly raised advice should be given serious consideration in keloid, or a telltale rupture. view of the fact that many of the postoperative It should be the surgeon's aim employ the wound complications already mentioned fre- type of incision that he considers to be most quently follow in the wake of abdominal opera- suitable for the particular case with which he tions. Ronald Reid stated: is dealing, and in doing so he must achieve the three essentials: (1) accessibility, (2) extensi It is not uncommon to see a surgeon cutting urity. Therefore, in my oprietes to perform some internal operai his way briskly through the abdominal pa- ion, not only should he make the correct incision ticulously, and finally leaving the closure to but also should suture the wound efficiently himself, except when assisted by one of his own colleagues who not only is able but also has made a special study of the techniques of ab tion in the abdominal wound and the patient's dominal operations. Some assistants, capable safety, and maybe his life, thereby risked un- though they may be, may not necessarily (italics added). an assistant of limited experience. In conse- quence, the most brilliantly devised and exe- cuted operatio n may be marred by complica

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