OrthoNet

Pubic symphysis -anterior approach

* position - supine

* incision - 15cm curved incision in line with skin crease about 1 cm above pubic symphysis

* no internervous plane

* dissection
- deepen incision to ant. portion of rectus sheath
- ID & ligate superficial epigastric art. & vein
- divide rectus sheath transversely about 1cm above symphysis
- divide both rectus muscles 2-3mm above their insertion (likely torn)
- retract rectus sup. to reveal pubic symphysis
- push bladder gently off back of bone
- potential space = space of Retzius

* dangers
- bladder - gently push bladder off post. aspect of pubic symphysis