Logan Steele
Surgery is a vast topic, and the procedures depend on the type of injury, the damage, and the urgency of the situation. While surgeons try to avoid cutting through muscle, it is sometimes necessary. In the case of a caesarean section, for example, a small cut is made in the abdominal muscle, and then the surgeon tear or stretch the muscle to make the hole bigger. This is because tears heal better than sharp cuts. In other cases, surgeons may cut away damaged or inflamed tissue, or scrape down calcium deposits. Surgery is often a last resort, and the patient's post-surgery rehabilitation efforts will impact their recovery.
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What You'll Learn
Caesarean sections
A Caesarean section, or C-section, is the surgical delivery of a baby through an incision made in the birth parent's abdomen and uterus. It is performed when it is deemed safer for the birth parent, the baby, or both.
During a C-section, the surgeon will make deeper incisions through the tissues and separate the abdominal muscles until the uterine wall is reached. The rectus muscles in the midline are separated, and the abdominal cavity is accessed by opening the peritoneum, either sharply or bluntly. The peritoneal incision is then typically extended bluntly, and a bladder blade may be placed to provide better visualisation of the lower uterine segment. The surgeon will then make a final incision in the uterus, which can be horizontal or vertical, and the baby is delivered through this opening.
The abdominal muscles are not cut during a C-section; instead, they are separated or pulled apart to allow the surgeon to access the uterus. However, the procedure does involve cutting through the layers of fascia, which is the connective tissue that surrounds the abdominal muscles. This can affect the function and recovery of the core muscles, and the formation of scar tissue can interrupt the muscular layers' ability to glide over one another during contraction and relaxation.
After the baby is delivered, the umbilical cord is clamped and cut, and the placenta is delivered manually or spontaneously. The provider will then stitch the uterus and close the muscle and tissue layers with sutures or staples. The skin incision is closed with stitches or surgical staples, and a sterile bandage is applied.
C-sections typically require a hospital stay of at least two to three days, and full recovery can take between four and six weeks. It is important to follow the prescribed analgesics and maintain them as instructed.
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Muscle tears
Muscle strains, or pulled muscles, are common but painful injuries. They occur when the fibres of a muscle tear apart due to being stretched beyond their limit. This can happen suddenly, for instance, during sports or everyday activities, or gradually due to overuse. Some muscles are more susceptible to tearing than others, including those that cross more than one joint, contract eccentrically, and have type II muscle fibres.
A torn muscle will feel sore when used, and the pain can usually be located in one spot. The pain may develop gradually over a few days or be felt immediately, and the muscle may feel weak or unable to be used at all.
Certain conditions, such as scleroderma, vasculitis, and myositis, can cause muscle pain and inflammation. Infections such as influenza, coxsackievirus, and Lyme disease can also lead to muscle aches and weakness. Additionally, hypothyroidism, hyperthyroidism, hyperparathyroidism, and hypoparathyroidism have been associated with muscle problems.
During surgery, surgeons try to avoid cutting through muscles as much as possible. They will usually only make small cuts or tears if they need to access structures underneath. This is because tears heal better than sharp cuts, and muscles are also protected by a film called fascia, which can help bear some of the damage.
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Muscle resection
During muscle resection, the surgeon will cut into the muscle and remove a portion of it, typically along with a part or all of the tendon. This process of shortening the muscle is often done to tighten it. The shortened muscle is then reattached to the original insertion site.
The procedure typically involves making an incision in the outer white covering of the eye, known as the conjunctiva. The surgeon will then use a hook to pull up on the muscles that need to be adjusted. They may cut into the muscle, remove a portion of it, and then reattach it in a shortened state. This process helps to align the eyes so they can work together.
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Arthroscopic surgery
During arthroscopic surgery, the surgeon makes small incisions in the patient's skin, usually two or three, and inserts a pencil-sized instrument called an arthroscope. This instrument contains a small lens, a lighting system, and a miniature camera, which allows the surgeon to see the interior of the joint on a video monitor. The light is transmitted through fibre optics to the end of the arthroscope, which is inserted into the joint. Additional instruments, such as lasers, may be inserted through separate tiny incisions to perform the surgery.
After arthroscopic surgery, the small incisions are covered with a dressing, and the patient is moved to a recovery room. Most patients require little or no pain medication, and many are able to return home within 1-2 hours with care instructions. The surgeon will provide instructions on caring for the incisions, activities to avoid, and recommended exercises to aid recovery. A follow-up visit is typically scheduled to inspect the incisions, remove sutures if necessary, and discuss the patient's rehabilitation program.
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Emergency procedures
Surgery is often an emergency procedure to treat trauma or acute illness. It involves cutting or penetrating the body's tissues and carries varying degrees of risk. For instance, during a caesarean section, surgeons cut through the abdominal muscle to deliver a baby. They make a small hole, stretch it, and then tear through the muscle, as tears heal better than sharp cuts.
In emergency surgeries, a midline abdominal incision is commonly used as it provides relatively bloodless access to the abdomen and pelvis. This involves cutting through the avascular plane of the linea alba, which is advantageous in emergency situations as it offers extensive exposure.
In cases of inguinal hernia, a common groin injury, surgeons cut through the subcutaneous fat and the external oblique muscle to reach the intestine and pull it back to its original location. The incision is made approximately 1 cm above and parallel to the inguinal ligament.
Another example of emergency surgery is a thoracotomy incision, which provides access to the thoracic cavity. This involves dividing the latissimus and serratus anterior muscles down to the chest wall and then cutting through the intercostal muscles over the eighth rib.
Additionally, in the case of a blocked carotid artery in the neck, an emergency surgery called a carotid endarterectomy may be performed to prevent a stroke. This involves making an incision in the neck to access the affected artery and remove the blockage.
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Frequently asked questions
Yes, surgeons do sometimes cut through muscle. This is usually done as a last resort when all other treatment options have been exhausted.
The type of surgery performed depends on the level of pain, the type of injury, and the amount of damage. In emergency situations, a surgeon may opt for a procedure that balances speed and damage.
There are various procedures for cutting through muscle, including arthroscopic surgery, debridement, and resection. Arthroscopic surgery is a minimally invasive procedure used for less extensive damage. Debridement involves cutting away damaged or inflamed tissue and is often performed during open muscle surgery. Resection procedures are commonly used to treat strabismus.
After cutting through muscle, the surgeon will close any incisions with sutures, staples, or thread. The patient will likely need physical therapy and rehabilitation to recover functionality.
Cutting through muscle can be risky as it may damage surrounding nerves and blood vessels. Additionally, there may be cosmetic concerns following muscle resection procedures, such as redness and visible sutures.
