- The patient was a 32-year-old G1P1 with fundal subserosal (FIGO type 7) fibroid, measuring 17cm.
- A Maylard incision is planned, which increases exposure and access to the pelvic sidewalls, compared to a Pfannenstiel incision, while allowing for a transverse skin incision.
- The incision involves dividing the rectus muscles, as well as the inferior epigastric arteries, located at the postero-lateral border of the rectus muscles.
- The uterus was exteriorized from the abdominal cavity, along with the fibroid.
- A Penrose drain was passed through the broad ligament windows and secured anteriorly to temporarily occlude blood flow through the uterine arteries to minimize bleeding.
- Dilute vasopressin was injected as an acute vasoconstrictive agent, at the proposed site of excising the fibroid.
- The fibroid was carefully removed and the myometrial defect was re-approximated in layers.
- The uterine serosa was re-approximated using a baseball or herringbone suture technique.
- The peritoneum is closed, along with the fascia and skin. The rectus muscles will heal spontaneously without sutures.
Contradictions to Maylard incision
- Patients with with significant peripheral vascular disease, as the inferior epigastrics are important as collateral circulation to lower limbs in this population.
Hapugoda S, Uterine leiomyoma (fibroid) classification system (illustration). Case study, Radiopaedia.org