The post-it states “Skin is a map of your history.”
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Incisions
Injuries
Wrinkles
Stretch marks
The well-trained medical professional can tell.
Incisions are surgery scars that tell us what kind of surgery you’ve had in the past. Whenever I have abdominal pain patient on the table that is less than forthcoming with their history.
Why a cesarean section where they cut the baby out through SEVEN tissue layers is considered MINOR SURGERY and not worth mentioning, I will never know.
Even before the surgeon makes incision into your abdomen, we can read it like a book and even make suppositions about why there is an incision scar there. There is a scar on the right lower quadrant, with a history of appendectomy is most likely a McBurney incision. There is a scar on the right upper quadrant, just below the ribs is for the removal of your gallbladder, also known as a Kocher incision.
The smiley-faced incision just above the pubis is called the Pfannenstiel incision and the cesarean section incision. You know, the one that NO ONE ever remembers to include in their surgical history. Someone should do a study. Wait, that’s me.
The smiley-faced incision that that goes from hip to hip low on the abdomen so you can still wear a swimsuit (!) is an abdominoplasty incision scar. This means that a plastic surgeon removed excess fat and skin from the abdomen, pulled the remaining skin taut, and created a new hole for the belly button. In my head, I call in my head the why-so-serious incision (IYKYK). Joker approved.
The midline incision scar is smack in the center of your abdomen. This can be of differing lengths and they all say something different. A short incision that went toward your ribs could have been used for esophageal or stomach surgery, especially a bleeding ulcer. A longer incision that starts above the belly button and ends below the belly button can be used for the small intestines, or to get the specimen out after laparoscopic colon surgery. I use the midline incision to describe to the PACU nurse the extent of the abdominal surgery. I tell them if it is an upper incision, a middle incision, or a lower incision. Sometimes the incision has to be from xiphoid to pubis, or from where the ribs join, to the end point of the abdomen. When I am reporting off to the PACU nurse I call this the full monty, meaning that it is the ENTIRE abdomen that has been flayed open and, yeah, the patient is going to hurt. This xiphoid to pubis incision might mean that the surgeon was searching for the point of bleeding, or had to remove the entire colon. It is a big deal type of incision.
There may be small 1/2 inch incision scars that indicate previous laparoscopic surgeries. They may be only 1 inch away from another lap incision scar but that indicates different kinds of laparoscopic incisions. Surgeons try to use previous incisions for surgical sites, but sometimes they can’t because of placement, and you, the patient, end up with similar but not the same spot scars.
There may be an abdominal incision scar that indicates that a hernia was repaired.
There may be an abdominal incision scar that indicates a kidney transplant.
There are a lot of surgical scars.
But not every scar is surgical.
There are the tattoo removal scars.
There are the gunshot scars.
There are the belly button piercing scars that looked so badass in your teens and 20s and now are just a reminder of your past self.
There might even be fell out of the tree at 9 scars. Or the car accident or bike accident scars.
We can tell.
And that is only the abdominal scars.
This is apparently a new series I’ve begun for Sundays.
Come back next week for chest scars.
Dispatches from the Evening Shift 