c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Appendectomy: 13

A D V E R T I S E M E N T

   
 

Using two large blunt clamps (Pean) perpendicular to each other, the muscle fibers are spread down to the level of the transversus.       

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Appendectomy: 14

A D V E R T I S E M E N T

   
 

Two fingers are used to gently spread the internal oblique fibers, making room to place two retractors.       

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Appendectomy: 15

A D V E R T I S E M E N T

   
 

Care must be taken in spreading the internal oblique. The iliohypogastric nerve is found laterally in the cleft between internal oblique and transversus muscles. Excess stretching can tear the vasa nervorum running with this nerve. Clamping to control the bleeding can injure the nerve.      

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This page was last modified on 12/5/1999.