Paramedian incision.

England, c.1980.

1 positive film reel (10 mins.) : silent; colour

More material relating to the Graves Medical Audiovisual Library is in the Wellcome Library reference SA/GMR.

One of several films created as a result of the research work carried out by F. T. (Frederick Thomas) Graves between 1952 and 1986 at University College Hospital, Kings College Hospital and Staffordshire General Infirmary. F. T. Graves was the brother of John Graves (1923-1980) who set up the Graves Medical Audiovisual Library with his wife Valerie.

From accompanying notes: 'This incision can be made in any one of four sites in the abdomen, - right and left, above the umbilicus and right and left below the umbilicus. The length of the incision can also be varied, so that the opening can be large or small and it can also be made partly above and partly below the umbilicus. it is therefore an incision of considerable versatility. Incision through the skin and subcutaneous tissue - Haemostasis and the application of skin towels. - Incision in the anterior rectus sheath - the underlying peritoneum, between two artery forceps, - at first with a knife and then with scissors - Insertion of an examining finger - discovery of local adhesions - cautious separation of adhesions and the exposure of the underlying bowel. Closure of the Incision; Picking up the edges of the peritoneum and posterior rectus sheath with artery forceps. - Closure with continuous catgut suture using a knotting stitch at intervals - Insertion of deep tension stitches - Note that these are passed from skin and through the muscle anterior to the peritoneum and always under direct vision. This is done to avoid the possibility of the needle passing too deep and entering the peritoneal cavity of its contents. Note also that the Tension sutures are placed, but not tied before the sutures are inserted in the anterior rectus sheath. - Incision in the Anterior rectus sheath is closed with interrupted sutures. - Skin closed with continuous everting stitch and it is not until the skin has been completely closed that the Deep tension sutures are tied. - Note the sleeves of rubber tubing on the deep tension sutures. These are present to reduce discomfort by the tension of the tension sutures against the skin.'

Wellcome Trust 2016