This document discusses various types of abdominal incisions used in surgery. It describes 7 main incisions: vertical midline, para median, Kocher's subcoastal, McBurney's gridiron, Lanzy's, Pfannenstiel, and Rutherford Morrison. Each incision is defined by its location and layers cut. The vertical midline extends from the epigastrium to hypogastrium and is used for procedures like gastric surgery and C-sections. The para median is lateral to the midline and used for procedures like CBD surgery. Kocher's subcoastal is oblique below the subcostal margin and used for procedures like cholecystectomy.

1. SURGERY AND
ABDOMINAL
INCISIONS
UMAR TARIQ
MSC
ANAESTHESIA/OTT

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.

7. 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.

9. 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

11. 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)

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

13. Vertical midline incision is given in 3 layers
1. In 1st layer skin and subcutaneous 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 peritoneum
are incised by a small surgical knife or scissor.

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

15. 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

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

17. Para median incision is given in three
layers
• 1st layer skin and subcutaneous tissue
• 2nd layer anterior rectus sheath
• 3rd layer posterior rectus sheath is incised
along with transverse fascia and peritoneum
are incised in one layer

18. CLOSURE
• 3rd layer is sutured with catgut
• 2nd layer with vicyrl
• 1st layer is sutured with silk

19. KOCHERS SUB COASTAL
INCISION
• it is an oblique incision given in sub coastal
region.
• The incision starts from epigastrium 2 cm
below the xephoid process and lies 2 cm below
the sub coastal margin
• Right Kocher's sub coastal incision is given for
cholecystectomy.
• Left Kocher's sub coastal incision is given for
spleinectomy

20. This incision is given in four layers
In 1st layer skin and subcutaneous tissue is
incised
2nd layer anterior rectus sheath is incised
3rd layer muscles are incised e,g rectus muscle,
external oblique muscle, internal oblique
muscle, transverse abdomens
4th layer posterior rectus muscle is incised with
transversalis fascia and peritoneum

21. CLOSURE
• 4th layer is sutured with catgut
• 3rd and 2nd layer is sutured with vicyrl
• 1st layer is sutured with silk

23. MC BURNEYS GRID IRON
INCISION
• It is an oblique incision given perpendicular to
right spino umbilical line at MC Burney's
point.
• Mc Burney's point is a junction of lateral 1/3rd
and medial 2/3rd of the right spino umbilical
line.
• This incision is commonly used for
Appendicectomy

24. This incision is given in 4 layers
• In 1st layer skin and subcutaneous tissue are
incised
• In 2nd layer anterior rectus sheath is incised.
• In 3rd layer muscle fibers (external oblique and
internal oblique) are incised
• In 4th layer posterior rectus sheath is incised
along with transverse fascia and peritoneum.

25. CLOSURE
• Back in layers

26. LANZY`S INCISION
• It is the modification of MC BURNEYS grid
iron incision
• In lanzys incision skin and subcutaneous tissue
are incised at spino umbilical line.
• The internal layer are incised similarly as Grid
iron incision.
• The lanzy`s incision is used for
appendicectomy in young adult females
because of its cosmetic results.

27. • Lanzy`s incision is a transverse incision given
on the right side of the abdomen on the
interspine crease.

28. PFANNENSTIEL INCISION
• It is a transverse incision slightly convex given
just 1-2 cms above pubic hair line
• This incision has cosmetic results and is
widely used in gynaecology and obstetrics like
TAH,LSCS
• It is also used for prostate procedures in males.

29. This incision is given in 4 layers
• In 1st layer skin and subcutaneous tissue are
incised
• In 2nd layer anterior rectus sheath is incised.
• In 3rd layer muscles like rectus abdominis
muscle are incised
• In 4th layer transversalis fascia and peritoneum.

30. CLOSURE
• Back in layes

31. RUTHERFORD MORRISON
INCISION
• It is similar to the grid iron incision, however
cuts through the underlying muscle
• Used for appendicectomy
• Useful in right and left sided colonic
resections, sigmoid colostomy

33. BATTLE INCISION
• It is a lower right paramedian incion but placed
more laterally than the standard para median
incision
• It is suitable for dealing with acute
appendicitis and pathologies in the right lower
quadrant of the abdomen.