Coo-oo-ool! (And slightly whoozifying.) Thanks for all the detail.
So where I was reading that some appedectomies (when sloppy perforatations have occured) are left “open” and drains are not used, are the tendon layers still sutured shut?
(One site mentioned leaving the wound open “instead of” inserting a drain.)
It can depend on how old the perforation is. In the days of ‘missed appendicitis’, someone’s appendix would burst, and they would either die of peritonitis/sepsis or their body would wall off the infection and form a big abscess, which could actually go on to erode through the abdominal wall and come to a ‘point’ at the level of the skin. There would be so much inflammation and scar formation around the abscess cavity that you could safely open the abscess at the skin and not have to worry too much about closing the belly wall - not that you could even if you wanted to, mind you. There are still such cases, but they are uncommon.
A very conservative surgeon facing a ‘freshly’ ruptured appendix may do a peritoneal lavage, place a drain in the peritoneum through a separate stab incision, close the fascia (the tendon layer/s) and leave the skin and fat open. Others may avoid the peritoneal drain and irrigate, close the fascia, and leave the skin open. Or they may close the skin over a simple rubber-band type drain, or just close everything up and rely on antibiotics and the overall health of the patient. It’s a judgment call and depends on the amount of contamination and other factors. You can get away with closing wounds in children that you would leave open in the elderly or smoking/malnourished/comorbid patients. It would be normal to close the fascia whenever possible, though.
Fascinating, thanks!
I guess in my naivety (even after seeing the Bodyworlds exhibit), I still sort of pictured people to be made more like water balloons. Just skin (and the layer of muscle) then the squishy stuff inside. That’s the anatomical “theory” I think I came up with when I was 5 years old and that idea persists, even when I know better.
I only first heard of fascia two years ago from my RMT when I was geting a massage. And I had no idea that there were separate cavities in one’s trunk (thoracic, abdominal, and… uh… the other one). So I find it all quite amazing and interesting.