all about the incisions of abdominal wall for physiotherapy students

1. DR. PRASHANT KAUSHIK
MPT (SPORTS)
ASSISSTANT PROFESSOR
KINPMS

2. An incision is a fine cut made by a surgeon during
surgery.
Abdominal incision ->Incision on abdominal wall

4. 1.Midline Incisions-A vertical incision which follows the
linea alba.
It may be:
- upper midline incision
-lower midline incision
-single incision

5. Advantages-
-almost bloodless (Because the linea alba is anatomically narrow at the
inferior portion of the abdominal wall, the rectus sheath may be opened
unintentionally, although this is of no consequence)
-no muscle fibers aredivided
-no nerves are injured
-good access to upper abdominalviscera
-very quick to make as well as toclose
-can be extended full lenght of abdomen curving around umblicalscar
Disadvantages-
-Cosmetically not approved
Used in surgeries like Like in perforated appendix, twisted ovarian
cyst, ileal perforation.

6. 2.Para median Incision- It is made 2to 5cm lateral to
umbilicus.

7. Advantages-
-vertical incision to right or left,provides access to lateral str. suchas
spleen or kidney.
-closure is theoretically more secure because rectus muscle can act as
a buttress between reapproximated posterior and anterior fascial
planes
Disadvantages-
- It tends to weaken and strip off the muscles from its lateralvascular
and nerve supply resulting in atrophy of the muscle medial to the
incision.
-The incision is laborious and difficult to extend superiorly asis
limited by costal margins.
-It doesn’tgive good accessto contralateral structures.
- Comparatively more bleeding

8. Advantages:
- best cosmetic results
- less painful
-faster healing postoperative
- greater strength
Disadvantages:
-more time-consuming
-more haemorrhagic
- compromised ability to explore upper abdominalcavity
- division of multiple layers of fascia and muscle and nerves,
may result with haematoma or seroma in potential spaces.

9. Is started at midline ,2 to 5 cm below the xiphoid,and
extends downwards outwards and parallel to and
about 2.5 cm below costal margin
-It affords excellent exposure to gall bladder and biliary
tract and can be made on left si
to spleen.
-Especially used in cholecystecto
de to afford access
my

10. is divided into :
-Chevron (Roof Top) Modification-
Rooftop incision used forgastrectomy,
oesophagectomy, pancreatectomy,
hepatic resection, and liver
transplantation.
-The Mercedes Benz Modification-
bilateral Kochlar incision with
extension upto xphisternum
,classically used for liver
transplantation , diaphragmatic
hiatuses.

11. In newborn and infants, this incision is preferred bcs
more abdominal exposure is gained per lenght of incision
than with vertical exposure
Because infants’ abdomen longer transverse than vertical
girth.

12. Incision is made at the McBurney point.
Originally placed the incision obliquely from above
laterally to below medially.
Incision of choice most appendicectomies
Similar incision can also used in left lower
quadrant to deal with certain lesion of sigmoid
colon such as drainage of diverticular abscess ( an
inflammation or infection
in one or more small
pouches in digestive
tracts)

13. It is a variation of mcburneys incision that is made the
same point but in transverseplane.
It gives cosmetically goodscar.

14. Rutherford-Morrison Incision
Extension of McBurney incision by division of oblique
fossa
Can be used for right and left sided colonic
resection, caecostomy or sigmoid colostomy

15. Used frequently by gynecologist and urologist for
access to pelvic organ, bladder, prostate and for c-
section.
is usually 12 cm long and is made in skin fold
approximately 5 cm above symphysis pubis

16. gives excellent exposure to pelvic organ
Skin incision is placed above but parallel to
traditional placement of Pfannenstiel incision
MAYLARD INCISION

17. Either right or left
Converts pleural and peritoneal cavities into one
common cavity
Thereby gives excellent exposure
Right incision may be particularly useful in elective
and emergency hepatic resections
Left incision may be used in resection of lower end
of esophagus and proximal portion of stomach.
Incision is extended along line of 8th intercostal
space,the space immediately distal to inferior pole of
scapula.

20. 1. Kochlar
2. Median
3. Mc-Burney
4. Battle
5. Lanz
6. Para-Median
7. Transverse Muscle Cutting
8. Oblique MuscleCutting
9. Pfannenstiel