The document describes various types of abdominal incisions including vertical, transverse, and oblique incisions. Vertical incisions include median and para-median incisions while transverse incisions include Pfannenstiel and Lanz incisions. The goals of any incision are accessibility, extensibility, and reliable closure while minimizing functional impairment and hernia risk.
2. •Surgical Incision is a cut made through the skin to
facilitate an operation or procedure.
•It should be the aim of the surgeon to employ the
type of incision considered to be the most suitable
for that particular operation to be performed.
• In doing so, three essentials should be achieved:
1.Accessibility
2.Extensibility
3.Areliable closure
3. Principles
Adequate exposure for easy accessibility of organ
It should be muscle splitting rather than cutting
- Except for the RM which can be cut transversely
because of its rich blood supply
Nerve should not be divided
Incision should extensible
4. Principles
Least interference with the function of the
abdominal wall
Insert DT through a separate incision
Close the wound layer by layer
9. Classification According to the muscle
No muscle divided
Muscle splitting
Muscle dividing
Median
Para median
Pararectal
Through linea semilunaris
Para median
Lateral
Transrectal
Superior
Middle
Inferior
10. 1. MEDIAN INCISIONS
Supra-umbilical
Infra-umbilical
VERTICAL INCISIONS
Supra umbilical
Infra umbilical
11. • SIGNIFICANCE-it is favoured In diagnostic laparotomy,
as it allows wide access to abdominal Cavity.
• ACCESS
Supra umbilical- stomach,duodenum,gall bladder, liver,
bile duct, and pancreas
Infra umbilical- intestine, appendix, urinary bladder,
prostate, rupture and ectopic Pregnancy
Mid lines - small and large bowel
12. Advantages
Quick and good access for emergency surgery
Almost bloodless
Very quick to make as well as to close
No muscle fibers are divided
No nerves are injured
Good access to upper abdominal viscera and both
side of abd. Can be reached
Can be extended full length of abdomen curving
around umbilical scar.
Supra umbilical part heals well as it is thick, strong,
and hold suture well
13. Disadvantage
Healing in infraumblical region is bad as linea alba is
thin and weak there for complication of burst
abdomen and incision hernia
Injury to the falciform ligament
Midline scar
Bladder injury
15. •Placed 2 to 5 cm lateral to midline over median aspect
of bulging transverse convexity of rectus muscle
•Rectus retracted 1inch from the midline on either side
Access
Rt.upper paramedian
stomach, duodenum, gallbladder, head of pancreas and
Rt.lobe of liver
Lt.upper paramedian
oesophagus, cardia of stomach, spleen, left lobe of
liver
16. Rt.lower parmedian
Appendix, female genital organs
Lt.lower paramedian
sigmoid and descending colon
Mid paramedian
Exploratory laprotomy
Pathology is not known
Multiple and extensive pathology
17. Advantage
Access and extend up and down
Provides access to lateral structures
Closer is secure specially in muscle retracting type as
muscle comes over it
Less chances of incisional hernia
19. Para rectal (Battle’s incision)
Median to outer border of rectus muscle
Muscle retracted medially
Features
Perpendicular to midline 1/3 of spino umbilical
line
1/3 above and 2/3 below the line
Access
Appendix
Pelvic with extension
Colon with extension
20. Advantages and disadvantages
Rectus muscle is not cut
Good healing
Damage to Nerve supply rectus cause muscle atrophy
Accessibility limited
Hernia
22. •The incision may be continued across the midline into
double kocher’s incision or rooftop appearance which
provide excellent access to upper abdomen particularly
in those with broad costal margin
•Here both recti are cut transversely
•Uses-
•Total gastrectomy
• Total oesophagectomy
• Extensive hepatic resection
• Bilateral adrenectomy
24. • Used frequently by gynaecologist 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.
• Here rectus sheath and skin is cut transversely along the
lower abdominal skin crease, However, rectus muscle are
separated in the middle and laterally.
This is employed specially for approach to bladder and
uterus.
25. Transverse incisions(cont.)
3.Maylard Transverse Muscle Cutting Incision
•Gives excellent exposure to pelvic organ
•Skin incision is placed above but parallel to
traditional placement of pfannenstiel incision
26.
27. Transverse incisions(cont.)
4. Lanz incision
•It is a variation of McBurneys incision that is made
the same point but in transverse plane.
•It gives cosmetically good scar
28.
29. Transverse incisions(cont.)
5. Transverse Muscle dividing(mid abdomen)
•In newborn and infants, this incision is preferred bcs
more abdominal exposure is gained per length of
incision than with vertical exposure
•Because infants’ abdomen longer transverse than
vertical girth.
•Also true of short, obese adult
32. •It affords excellent exposure to gall bladder and biliary
tract and can be made on left side to afford access to
spleen.
Oblique incision From 1 cm below the xiphoid process
to down wards to Rt.and parallel to costal margin and 2
finger breaths below it. 10- 12 cm long
Access-
Lt.spleen and Rt.liver, gall bladder
Advantage & Disadvantage–
Good exposure to liver and gall
bladder(cholecystectomy)
Muscle and nerve cutting - chances of hernia
35. Perpendicular to spinoumbilical line
At the junction of lateral 1/3 and medial 2/3 of line,
and 1/3 above and 2/3 below the line
Access-
Rt.Appendix, caecum, colostomy,
Advantage disadvantage
Muscle splitting – no post operative hernia
No damage to muscle and nerve
Direct approach to appendix
Abdomen can not be explored
Difficulty in dealing with appendix which is not
easily found
36. Rutherford Morison
Oblique Muscle Cutting
Incision
Extension of McBurney
incision by division of oblique
fossa
Can be used for right and
left sided colonic resection, or
sigmoid colostomy
Some other incisions
37. Mercedes benz modification
Consists of bilateral low kocher’s incision with
upper midline incision upto the xiphisternum.
Provides excellent access to the upper abdominal
viscera mainly the diaphragmatic hiatuses
40. 2.POSTERO-LATERAL INCISION
This follows the Vertrebral
border of scapulaAnd the line
of rib (numbers 5,6,7, or 8)
to theAnterior angle or
costal margin
Thoracic incisions(cont.)
41. ANTERO-LATERAL INCISIONS
•This start close to the midline in front, follows along
the line of the rib below the breast to the posterior
axillary line.