This document discusses surgery and surgical incisions. It introduces surgery and its branches, then focuses on abdominal incisions. There are 7 main abdominal incisions described: vertical midline, para median, Kocher's subcoastal, McBurney's gridiron, Lanzy's, Pfannenstiel, and Rutherford Morison. The vertical midline incision involves making cuts through 3 layers - skin/subcutaneous, linea alba/muscles, and transverse fascia/peritoneum. It is then closed back in layers. The para median incision is a vertical cut 2-4cm from the midline and is commonly used for right upper (CBD) and left lower (sigmoid colon

1. SURGERY

2. INTRODUCTION
• It is the branch of medical science, which is
concerned with the treatment of diseases and
defects by operation and manipulation.
• Surgery is used for diagnosis and treatment of
diseases, besides correcting deformities.
• It is also used for reappear of injuries.
• The modern surgery includes
i. preoperative diagnosis
ii Intraoperative judgement and management
iii Post operative care of the patient

3. On the basis of organ system involved and techniques used in
surgery. It has been classified into 13 different branches
1. General surgery
2. Orthopaedics
3. Urology
4. Gynaecology and obstetrics
5. Neuro surgery
6. Plastic surgery
7. ENT
8. CVTS
9. Micro surgery
10. Cryo surgery
11. Paediatric surgery
12. Ophthalmology
13. Dental surgery

4. Abdominal cavity is divided into 9 regions by:
1. Two mid clavicular lines.
2. One sub coastal line.
3. One interspine crease.

5. SURGICAL INCISION
An incision is a cut made into the skin, tissue of
the body to expose the underlying tissue, bone
or organ so that a surgical procedure can be
performed.

6. ABDOMINAL INCISIONS
In modern surgical practice 7 different incisions are
used for making an opening in the abdominal wall
which are
1. Vertical mid line incision.
2. Para median incision.
3. Kocher`s sub coastal incision
4. MC Burney`s grid iron incision.
5. Lanzy`s incision
6. Pfannenstiel incision.
7. Rutherford Morison incision

7. 1. VERTICAL MIDLINE INCISION
• It is the vertical incision given mid-line of the
abdominal wall.
• It can be upper abdominal, lower abdominal or
in combination depending upon the surgical
procedure
• The incision extends from epigastrium(just
below xiphisternum) to
Hypogastrium(symphysis pubic)

8. • Upper midline incision is used for gastric
procedures
• Lower midline incision is used for
gynaecology procedures like TAH, LSCS

9. Vertical midline incision is given in 3 layers
1. In 1st layer skin and sub-cutanous tissue are
incised by scalpel.
2. In 2nd layer linea alba and muscles are incised
by cautery or scalpel.
3. In 3rd layer transverse fascia and peritonium
are incised by a small surgical knife or scissor.

10. Incision closure
Incision is closed back in layers
Peritonium is closed by catgut
Lenia alba and muscles are closed by vicryl
subcutaneous tissue and skin are closed by
silk,nylon or prolene.

11. PARA MEDIAN INCISION
• It is the vertical incision given 2-4 cms
away(lateral) to the midline of the abdominal
wall.
• The incision may be
Right upper
Right lower
Left upper
Left lower

12. • The paramedian incisions are comonly used
for right upper and left lower
• Right upper paramedian incision is used for
CBD.
• Left lower is used for resection of sigmoid
colon