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I have on numerous occasions in my clinic called attention to the annoying and possibly dangerous proximity of the epigastric vessels to the wound in the vertical rectus incision, especially when made below the umbilicus. I have never been partial to the incision for the reasons suggested, but have used it rather frequently. In the future I shall employ it only in cases in which its advantages as compared with other incisions are very considerable, and in septic cases I shall use it in very exceptional ones only.
This decision is the result of the fact that, within the last month, I have had two cases of alarming secondary hemorrhage from the epigastric artery, one very nearly fatal. In both cases there was infection. In neither case was the artery injured at the time of the operation, so far as is known. The patients, both males, were aged respectively 36
PORTER MF. POSSIBLE DANGERS OF THE VERTICAL RECTUS INCISION. JAMA. 1912;LVIII(19):1442. doi:10.1001/jama.1912.04260050118012