Phenytoin Oral Suspension (Dilantin 125)- Multum

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The nondependent arm should be placed on a padded Mayo stand so that the arm cartilage de requin horizontal with slight forward rotation at the shoulder.

The bed is flexed until the flank muscles are under stretch. The bed is placed in Trendelenburg position so that the flank is rendered parallel to the floor. The patient is secured to the physica b journal part of the operating table with 2-inch-wide adhesive tape, which fixes the patient in place while allowing adjustment of flexion.

After sterile preparation and draping, the skin incision begins diarrhea newborn the costovertebral angle, approximately at the lateral border of the sacrospinalis muscle just inferior to the 12th rib.

The incision is made a fingerbreadth below and parallel to the 12th rib and is carried onto the anterior abdominal wall. In an attempt to avoid the subcostal nerve, the incision can be curved gently downward at Ext. If needed, the incision can be extended caudally or medially to the lateral border of the rectus abdominis.

The incision is carried sharply through the subcutaneous tissue, exposing the fascia of the latissimus dorsi and external oblique muscles.

Electrocautery is used to incise the muscles in the line of the incision, starting with the latissimus dorsi posteriorly (Fig. The posterior inferior serratus muscles, which insert into the lower four ribs, are also encountered in the posterior portion of the wound and transected.

In the anterior aspect of the wound the external oblique muscle is divided. These maneuvers expose the fused lumbodorsal fascia, which gives rise to the internal oblique and transversus abdominis muscles. The lumbodorsal fascia and internal oblique muscle are divided (Fig.

By using two fingers inserted into an opening created in the lumbodorsal fascia at the tip of the 12th rib, the peritoneum is swept medially as the transversus abdominis is split digitally. The subcostal nerve should be identified between the internal oblique and transversus abdominis muscles and spared (Figs. Internal Phenytoin Oral Suspension (Dilantin 125)- Multum muscle External oblique muscle Nerve 12 Latissimus dorsi Phenytoin Oral Suspension (Dilantin 125)- Multum Lumbodorsal fascia Serratus posterior inferior muscle Figure 60-6.

Dissection through flank muscles. The latissimus dorsi muscle has been divided to expose the lumbodorsal fascia and the posterior aspects of the abdominal muscles. Lumbodorsal fascia Quadratus lumborum muscle Figure 60-7. Opening lumbodorsal fascia to gain entrance to retroperitoneum. Position of the patient for the flank approach. Phenytoin Oral Suspension (Dilantin 125)- Multum the axillary pad. The kidney bar may be elevated if further lateral extension is needed.

Latissimus dorsi muscle Figure Phenytoin Oral Suspension (Dilantin 125)- Multum. Superficial incision through flank. The plane between Phenytoin Oral Suspension (Dilantin 125)- Multum chest wall and pleura is developed by entering the investing fascia surrounding the intercostal nerve, which allows an extrapleural dissection (Fig.

The slips of the diaphragm attached about sport the inferior ribs are transected. Transversus Latissimus dorsi (cut) Gerota fascia Subcostal n. Lumbodorsal fascia Sacrospinalis clay Incision Figure 60-8. The lumbodorsal fascia and transverse abdominal muscle have been divided to expose the Gerota fascia. The subcostal nerve and vessels pierce the lumbodorsal fascia posteriorly and course forward on the transverse abdominal muscle.

To maximize exposure in the posterior aspect of the incision, one may incise the posterior angle of the lumbodorsal fascia, exposing the sacrospinalis and quadratus lumborum muscles.

Dividing the costovertebral ligament permits superior retraction of the 12th rib if enhanced exposure is deemed necessary. A Bookwalter flank retractor is used for exposure.



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