The anterior wall is formed by the aponeuroses of the external oblique and half of the internal oblique.

1. Abdominal Wall
&
Abdominal incision

2. OBJECTIVES
• Introduction
• Layer of abdominal wall
• Cutaneous nerve
• Cutaneous artery
• Quadrant /Region
• Abdominal incision
• Complications

3. Abdominal Wall
Xiphoid process

6. Cutaneous artery

7. Quadrants and Regions
L1
L5

9. Abdominal Incision
key principles are:
• Incision that allow adequate
exposure
• Avoid nerve Injury and maintain
blood supply
• Incisions should try to follow
Langer’s lines
• Muscles should be split and not cut
(where possible)

10. Abdominal incisions can be
• Vertical
Midline incision
Paramedian incision
• Transverse
Lanz incision
• Oblique oriented.
Kocher’s incision
Pfannenstiel incision

11. Abdominal incision

12. Kocher ‘s- Right Subcostal incision
Used to gain access for the gall
bladder
run parallel to the costal margin
starting below the xiphoid and
extending laterally

13. Two modifications of Kocher incision
• Chevron / rooftop incision – the
extension of the incision to the other
side of the abdomen
• used for oesophagectomy,
gastrectomy, bilateral adrenalectomy,
hepatic resections or liver
transplantation

14. • Mercedes Benz incision – the Chevron incision with a
vertical incision and break through the xiphisternum
• classically seen in liver transplantation

15. Midline Incision
• Used in abdominal surgery in
which abdominal viscera to be
accessed.
• Emergency laparotomy can
run anywhere from the xiphoid
process to the pubic
symphysis, passing around the
umbilicus.

16. Lanz Incision
• Predominantly for appendectomy.
• Incisions are made at McBurney’s point
(two-thirds from the umbilicus to the
anterior superior iliac spine).
• Lanz incision is a transverse incision

17. Gridiron Incisions
• Predominantly for appendectomy
• Gridiron incision is oblique
• Muscle splitting type
• An oblique incision made
in the right lower quadrant
of the abdomen

18. Rutherford-Morrison incision
• 'hockey-stick' incision.
• oblique, curvilinear muscle-cutting incision
• Provide good access to the right or left
colon and bladder for renal
transplantation, colonic resection,
caecostomy

19. Pfannenstiel incision
• Incision is commonly called the "bikini line incision“
• most common method for Caesarian sections

20. Laparoscopic Port Sites
• Laparoscopic surgery (keyhole surgery)
• Small incisions to be made in the skin
Mainly done for gall bladder removal
• Nerve injury, incisional hernia or
contamination were minimized

21. Complication following incision
• Nerve injury
• Surgical site infection
• Wound dehiscence
• Incisional hernia

22. Wound dehiscence
Wound fails to heal
Re-open a few days after surgery (most common in abdominal surgery).
It can be divided into two clinical entities:
• Superficial
• Full-thickness

23. • Superficial dehiscence – the skin wound alone fails, with the rectus
sheath remaining intact
• Full thickness dehiscence – the rectus sheath fails to heal and bursts,
with protrusion of abdominal content

24. Incisional hernia
• Protrusion of peritoneal fold or an organ through a surgical incision.

25. Suprapubic catheterization
• Placement of a drainage tube into urinary bladder just above pubic symphysis
• Generally considered more comfortable for male patients with long term catheter
requirements.
• Percutaneous approaches are often performed under vision with a rigid or
flexible cystoscope
Technique
• open technique and percutaneous technique

26. Peritoneal dialysis
• Treatment for kidney failure that uses the lining of your abdomen, or
belly, to filter your blood inside your body.
Types of peritoneal dialysis
Continuous ambulatory peritoneal dialysis (CAPD)
Automated peritoneal dialysis

27. Endoscopic surgery
• Performed using a scope, a flexible tube with a camera and light at the tip
• Allows your surgeon to see inside your colon and perform procedures without
making major incisions, allowing for easier recovery time and less pain and
discomfort.

28. Thank you