Abdominal incisions

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QuotationMarkLeft.png Wounds heal from the sides, not the ends - make sure you can see what you are doing. QuotationMarkRight.pngSpratt, Sir L.

Contents

Ideal Incision

The ideal incision should have the following characteristics:

  • Easy to open
  • Minimise damage to tissues
    • Avoid cutting nerves
    • Split rather than transect muscles
    • Limit damage to fascia
  • Easy to close
  • Allow sufficiently strong closure
  • Allow sufficient access
  • Extendable if necessary

Factors to Consider

  • Type of surgery
  • Target organ
  • Body habitus
  • Previous operations
  • Speed
  • Operator preference/experience

Types of Incision

Midline

This is one of the most common and versatile incisions for abdominal surgery, allowing access to virtually all of the abdominal organs and the retroperitoneum, if necessary. After the skin and subcutaneous tisuses are incised, the linea alba is opened. The advantage of this incision is that the linea alba is relatively avascular and avoids damage to any muscles or nerves. It is easy to extendable superiorly towards the xiphisternum, and, inferiorly, towards the pubic bone. The linea alba and rectus sheath are strong enough to allow secure closure.

Transverse

  • Skin incision crosses fewer dermatomes

Subcostal

Also known as Kocher's incision. This can be right subcostal, used mainly for open cholecystectomy, or left subcostal, used mainly for splenectomy. A combination of both is called a roof-top incision, useful in gastric and hepatopancreatobiliary surgery. When extended up the midline (as may be required to implant a liver, for example) this incision may be called a Mercedes-Benz incision for its resemblance to the company's logo.

Right iliac fossa

This incision is used mainly to perform an appendicectomy, although it can be used to gain access to perform caecal decompression, appendicostomy and caecostomy.

Various eponymous incisions exist:

Pfannenstiel

  • For Caesarian sections and urological surgery.
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