一般的剖腹產的手術時間大約半個小時,約莫是烤一份雙層蛋糕的時間。要把新生兒帶到這個世界,手術刀必須劃過肚皮,腹壁,腹膜,子宮,但不能傷到嬰兒。時間太長可能造成胎兒窘迫。而中間可能會有500 到1000c.c. 的出血量:必須控制在這個範圍,否則媽媽會有生命危險。 對婦產科醫師而言,傷口講求務實密合,而母子均安已是最大的成功。接下來對皮膚傷口縫合的完美追求是錦上添花。
但對於許多經過剖腹產的媽媽而言肚子的傷疤很重要。"剖腹生產後可以穿比基尼"這件事已經成為順產之外主要的期望。 而或許是個性上使然,我也對於媽媽手術傷口疤痕最小化有種使命感的堅持, 甚至驕傲 。以至於雖然需要多花接近一倍的時間做多層次與小口徑手術針的縫合也是值得。最近開始使用微創手術放大鏡,對皮膚傷口的處理能比較細緻,而且我認為可以減少留疤的機會。
生產手術不同於切一塊蛋糕般簡單,但過程或許可以比擬於蛋糕的製作 -- 最終的內在的甜美與外在的完壁繫於對每一個步驟的堅持。
#剖腹生產後穿比基尼
#生產手術疤痕
#微創手術放大鏡
An uncomplicated caesarean section takes approximately half an hour -- about the same time it takes to bake a double-layered cake. To bring a newborn to this world, the scalpel must incise the skin, abdominal wall, peritoneum, uterus wall without hurting the baby. If it takes too long then it can cause fetal distress. During the process, about 500-1000 ml of bleeding is expected. More bleeding can be a medical emergency. As far as the obstetrician is concerned, wound closure needs to be water-tight and efficient. And to aim for perfect skin-closure may seem to be a lower-priority with all things considered.
But to most mums the scar on the tummy is an important parameter with which she judges the skills of the obstetrician (or any surgeon). And thanks to my OCD I have also aimed to minimise scar for my patients with the extra time it takes to close the skin. During skin closure, I have recently started using surgical loupe, a rare instrument for an obstetrician. However, i find it easier to manoeuvre the smaller sized suture that i choose to use and to handle the cutaneous tissue-- perhaps it will lead to less scar formation.
Obstetric surgery is not a piece of cake, but like making a cake, the final sweetness and perfect look are all closely related to the perseverance with perfection on each little step
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