The Incision

Abstract

The patient now lies on the table, anesthetized and ready for your knife. Before you scrub, carefully examine the relaxed abdomen. Now, you can feel things, which were impossible to feel in the tense and tender belly. You may feel a distended gallbladder in a patient diagnosed as an acute appendicitis, or an appendiceal mass in a patient booked for a cholecystectomy. Yes, this may also occur in days of ultrasound and CT. As a pilot prior the flight, go over the list: antibiotics given? Subcut heparin injected? Is the patient correctly positioned? Now you can go and scrub! You are the Captain of the ship — behave as one: the scene of a surgeon who directly enters the room with his scrubbed hands high in the air is pitiful.

Incisions heal from side to side, not from end to end, but length does matter.

When entering the abdomen, your finger is the best and safest instrument.