The Pfannenstiel Incision: Opening and Closing the Tummy

The first step to getting a pfannenstiel incision, often known as a bikini incision, is a cut in the abdominal skin, , it's just above the hair line.

Once the skin is opened it exposes the underlying fat, which may have blood vessels that have to be burned or tied off. In the case of obesity, the overlying fat layer can be quite thick and require a bit of time to open. Then the middle of the fascia layer, known as the linea alba, is opened.

Next this whole fascial layer has to be cut, in many cases this can be done bluntly by finger dissection.

Many women will have a tiny muscle called the pyramidalis muscle shown here that may have to be dissected off the lower level of the rectus muscle.The rectus muscle runs down the middle of your abdomen.

Most pfannenstiel incisions avoid avoid the deep epigastric vessels that are over on the side of the rectus muscles. The next step is working the fascia off the muscles so that a big enough opening for the surgery you need can be obtained.

In this picture the surgeon is clamping a small blood vessel that may be bleeding on the surface of the muscle. Now days this will likely be burned.

Any additional room is achieved.

The muscles are separated off the underlying layer which is the peritoneum of the abdomen. A thin, almost see-through layer.

In this diagram the thin peritoneal layer is being cut, but it can be opened bluntly in many cases.

Any extra opening in the peritoneum is then achieved, depending upon the type of operation and how much room your physician needs.

Closing the abdomen at the end of the surgery just reverses the steps, closing the peritoneum first.

Sewing the muscles together is often done, they will close in with the fascia above it as well.

The fascia is then closed. And of course the skin. The skin can be closed with staples or sutures, and recent studies show that sutures cause less infection. But infections are prevented by antibiotics, good nutrition, being thin, not being a smoker, and by good wound care. Some infections still will occur regardless the care, but most heal very well with appropriate treatment.

Pictures from 1953 Atlas of Pelvic Operations.

Passing Your Uterine Lining, Menstrual Period Norms

Decidual Cast Periods can be fairly easy, passing some tissue at a time, or off can come the whole lining in one piece called a decidual cast. Generally the lining of the uterus is only 6-8 mm thick at the time of the menstrual period, and it is shed gradually, a few cells at a time. The decidual cast is when the entire lining passes spontaneously. It's not uncommon, but it usually both uncomfortable, and alarming to some. But us women are designed to have some sort of periods Or Not? We have to pass tissue each month. Or Not? Are they good for us? Or Not? Do we want them? Or Not? Is this something that is individual? Or Not? It's a complex topic that I will be discussing a lot over my time in this blog. So lets start with basics: How much do we bleed and what are we loosing, and just what was this that the patient passed? And another basic: track your periods, and the Women's Health Practice site http://www.womenshealthpractice.com/media/pdf/menstrual_chart.pdf you

Endocervial polyps

2 cm Endometrial Polyp After Removal Polyps in the cervix are almost never cancerous, but can bleed or get infected and should be removed. The are not directly related to an endometrial or uterine polyp (which is a precancerous condition), but your gyno may want to make sure these two conditions do not co-exist.

Irregular Periods can Be the Sign of Other Medical Conditions

Heavy menstrual Bleeding Menstrual Period Norms The menstrual period's normal physiologic function to shed the lining and then prepare the lining for a pregnancy. Thus a sample of the lining under the microsope looks like it has glands within tissue. It’s hard to know if this is a heavy period, or one that is really so heavy that you need treatment without really checking completely with your gyno! Experts have used a number of definitions to determine if the period you are having is too heavy. Your perception is important. The actual amount of blood lost is important, but that can be determined by collecting each pad and weighing them before and after blood collection. So gynos have struggled with how to determine the formal definition of heavy bleeding. A basic check up, and a basic blood count, is not going to really make your version of heavy periods fit the typical “FDA” approved definition because that is defined by the exact amount of blood lost, which is los

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