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Malignant Disease:
Special Procedures

Staging of Gynecologic
Oncology Patients With
Exploratory Laparotomy

Subclavian Port-A-Cath 

Peritoneal Port-A-Cath

Application of Vaginal
Cylinders for Intracavitary
Radiation Therapy

Application of Uterine Afterloading Applicators
for Intracavitary Radiation Therapy  

Pelvic High-Dose Afterloader

Abdominal Injection of Chromic Phosphate

Supracolic Total Omentectomy

Omental Pedicle "J" Flap

Tube Gastrostomy

Total Vaginectomy

Radical Vulvectomy
With Bilateral Inguinal
Lymph Node Dissection

Reconstruction of the
Vulva With Gracilis Myocutaneous Flaps

Transverse Rectus
Abdominis Myocutaneous
Flap and Vertical Rectus
Abdominis Myocutaneous

Radical Wertheim
Hysterectomy With
Bilateral Pelvic Lymph
Node Dissection and With Extension of the Vagina

Anterior Exenteration

Posterior Exenteration

Total Pelvic Exenteration

Colonic "J" Pouch Rectal

Kock Pouch Continent Urostomy

Omental "J" Flap Neovagina

Ileocolic Continent Urostomy (Miami Pouch)

Construction of Neoanus
Gracilis Dynamic Anal

Skin-Stretching System Versus Skin Grafting

Gastric Pelvic Flap for
Augmentation of Continent Urostomy or Neovagina

Control of Hemorrhage in Gynecologic Surgery

Repair of the Punctured
Vena Cava

Ligation of a Lacerated
Internal Iliac Vein and
Suturing of a Lacerated Common Iliac Artery

Hemorrhage Control in
Sacrospinous Ligament
Suspension of the Vagina

Presacral Space
Hemorrhage Control

What Not to Do in Case of Pelvic Hemorrhage

Packing for Hemorrhage

Control of Hemorrhage
Associated With Abdominal Pregnancy

What Not to Do in Cases
of Pelvic Hemorrhage

What not to do in cases of pelvic hemorrhage is important to the gynecologic surgeon. Laceration of a large pelvic vein, external iliac artery, external iliac vein, internal iliac artery, or internal iliac vein can produce copious hemorrhage that will fill the pelvis immediately (Fig. 1). Suction with location of the lacerations is the first step. Finger pressure is important and will stop the hemorrhage in most cases.

What Not to Do. Nonvascular clamps such as the Kelly clamp crush arteries and veins and should not be used. Sutures on large needles placed blindly beneath the pool of blood not knowing precisely what tissue and what structure is being grasped, pinched, or sutured should not be used. Finger and pack pressure should be used until proper exposure of the vessel laceration can be made. This allows the operating room team to obtain proper vascular instruments, vascular suture, and cardiovascular needles. More damage can be created to the lacerated artery and vein by typical gynecologic clamps. Gynecologic suture and needles are frequently inappropriate in vascular surgery. Trying to place a suture in a hemorrhaging vein or artery is not a proper technique for repairing that artery or vein.





Copyright 2008 / Clifford R. Wheeless, Jr., M.D. and Marcella L. Roenneburg, M.D.
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