The document discusses various types of abdominal and thoracic surgical incisions. It describes incisions such as vertical (median, para-median), transverse (Pfannenstiel, Lanz), and oblique (Kocher, McBurney) incisions. Median incisions provide wide access to the abdominal cavity but have disadvantages like midline scarring. Para-median incisions provide lateral access but are cosmetically worse. Transverse incisions like Pfannenstiel are commonly used for gynecological and urological procedures. Oblique incisions give targeted access while minimizing muscle cutting.

1. Abdominal Incisions
Dr. Kaushik Patel, MPT
Assistant Professor
SPB Physiotherapy College

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.A reliable 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

5.  Classification
 Vertical incision
 Transverse incision
 Oblique incision
 Others

6. Vertical incision
 MEDIAN
Supra-umbilical
Infra-umbilical
 PARA-MEDIAN
Upper (Rt/Lt)
Lower (Rt/Lt)

7.  OBLIQUE
 Mc Burney's
 Kocher (sub costal)
 Sir Rutherford
 Postrolateral

8.  TRANSVERSE
 Lanz
 Pfannensteil’s
 Mid abdominal
 Rt.upper
 Maylard Transverse

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

14. 2.PARA-MEDIAN
 Upper(Rt/Lt)
 Lower(Rt/Lt)
Vertical incisions(cont.)

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

18. Disadvantage
 Cosmetically bad
 Tension
 Hernia
 More blood loss
 More time consuming
 Other quadrant accessibility is less

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

21. 1. Upper(suitcase incisions) or Chevron (rooftop)
modification
Transverse incisions

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

23. 2.Lower (Pfannenstiel incision)
Transverse incisions(cont.)

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

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

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

31. 1.Kochers/ sub-costal incisions
Oblique incisions

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

33. 2.Mc-burney incision
Oblique incisions(cont.)

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

38. Thoracic incisions

39. 1.MEDIAN STERNOTOMY
Thoracic incisions(cont.)

40. 2.POSTERO-LATERAL INCISION
This follows the Vertrebral
border of scapula And the line
of rib (numbers 5,6,7, or 8)
to the Anterior 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.

42. SOME OTHER INCISIONS

43. COMMON GYNAECOLOGICAL
INCISIONS

44. INCISION FOR MASTECTOMY

45. NAME THE NUMBERS…

46. ANSWERS
•1. Kocher
•2. Midline
•3. McBurney
•4. Battle
•5. Lanz
•6. Para median
•7. Transverse
•8. Rutherford Morison
•9. Pfannenstiel