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1、APX-RAYDEMONSTRATINGAPCTYPE2SYMPHYSEALSEPARATIONINLETVIEWDEMONSTRATINGSEPARATIONOFTHESYMPHYSISOUTLETVIEWThepatientisprepped,suchthatthesymphysisisexposedinferiorly,theumbilicussuperiorlyandtheASISlaterally.Theincisionbeginstwofingerbreadthsabovethesymphysispubis.Theincisionbeginstwofing
2、erbreadthsabovethesymphysispubis.Frequently,oneoftherectusheadsisavulsedfromoneofthesymphysealbodies.Occasionallythereisasplitintherectusfascia.RECTUSMUSCLEGelpiretractorsareplacedatthewoundedgestohelpidentifyScarpa’sfasciaandthentheexternalobliqueandrectusfascia.Thesofttissueiselevated
3、superiorlyandinferiorlyfromtheexternalobliqueandrectusfasciawiththeknifeheldessentiallyparallelwiththebody.EXTERNALOBLIQUEFASCIAThesofttissueiselevatedsuperiorlyandinferiorlyfromtheexternalobliqueandrectusfasciawiththeknifeheldessentiallyparallelwiththebody.Thelineaalbaiseasilyidentifie
4、dbyobservingtheconfluenceofthefibersoftheexternalobliqueinthemidline.FOOTHEADThedottedlineisplacedonthelineaalba;thefasciabetweenthetworectusmusclesisdividedsharplybutonlythroughthefascia.HEADFOOTFOOTBluntdissectionbetweentherectusmuscleisperformed,allowingprotectionoftheperitoneumproxi
5、mally,andbladderandbladderneckdistally.RECTUSMUSCLEHEADHEADFOOTTherectusisthendividedwithaBoviontopofthedigit.RECTUSMUSCLEHEADFOOTBLADDEROncetherectusissplit,abluntretractorcanbeplaced,eventuallyholdingbackthebladder.Inthisfigure,thebladderregionisvisualizedjustproximaltothesymphysealre
6、gionunderneaththerectus.FOOTRECTUSByliftingtherectussuperiorlywiththefinger,aHohmannretractorcanbeplacedthroughtheperiosteumatthesuperiorandproximaledgeofthesuperiorramusjustlateraltothesymphysealbody.HEADFOOTHEADRECTUSThisisusedtoretracttherectuslaterally.Withtherectusbeingheldlaterall
7、y,abovicanbeusedtocleanthesuperiorsurfaceofthesuperiorramusintheareainwhichtheplatewillbeplaced.SUPERIORRAMUSFOOTHEADSYMPHYSEALBODYRECTUSWiththelegsheldtogetherandtheretractorsinplace,thesymphysealseparationisalreadypartlyreduced.Thesuckeriswithinthesymphysealseparation.FOOTHEA
