Surgical İncision of abdomen

1. Stj.Dr. Aylin Mert
0902110019

2. Surgical Incision is a cut made through the skin to
facilitate an operation or precedure.
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.Security

3. Langer’s Line
correspond to
the natural
orientation
of collagen fib
ers in
the dermis,
and are
generally
parallel to the
orientation of
the
underlying
Incisions
made parallel
to Langer's
lines may heal
better and
produce less
scarring than
those that cut
across.

4.  Skin
 Subcutaneous tissue
 Superficial Fascia
-Camper’s Fascia-fatty superficial layer
-Scarpa’s Fascia-deep fibrous layer
 Deep Fascia(Gallaudet’s Fascia)
 Musculoaponeurotic Layer
-External Oblique Muscle
-Internal Oblique Muscle
-Transverse Abdominal Muscle
-Rectus Abdominis-Pyramidalis Muscle
 Fascia Transversalis
 Preperitoneal Fatty Tissue
 Peritoneum

5. Abdominal & Pelvic incisions
Vertical
Incisions
-Midline
-Paramedian
Transverse & Oblique
Incisions
Abdominothoracic
Incisions
-Kochler Subcostal Incision
-Transverse Muscle Dividing
-McBurney Incisions
-Oblique Muscle cutting
-Pfannenstiel Incision
-Maylard Incision

6. 1)Midline Incision
 Almost all operations in
the abdomen and
retroperitoneum
 Advantages:
-almost bloodless
-no muscle fibers are
divided
-no nerves are injured
-good access to upper
abdominal viscera
-very quick to make as
well as to close
-can be extended full
lenght of abdomen
curving around umblical
scar.

7. 2)Paramedian Incisions
 Has 2 theoretical
advantages:
-it offsets vertical incision
to right or left,providing
access to lateral str. such
as spleen or kidney.
-closure is theoretically
more secure because
rectus muscle can act as
a buttress between
reapproximated posterior
and anterior fascial
planes.

8. 2)Paramedian Incision (cont’d)
 Disadvantages:
1. It tends to weaken and strip off the muscles from its
lateral vascular and nerve supply resulting in atrophy of
the muscle medial to the incision.
2. The incision is laborius and difficult to extend
superiorly as is limited by costal margins.
3. It doesn’t give good access to contralateral structures.

9. 1)Kocher Subcostal
Incision
 It affords excellent
exposure to gall bladder
and biliary tract and can
be made on left side to
afford access to spleen.
 İs started at midline ,2 to
5 cm below the
xiphoid,and extends
downwarda, outwards
and paralel to and about
2.5 cm below costal
margin

10. 1)Kocher Subcostal Incisions(cont’d)
 is divided into :
-Chevron (Roof Top) Modification
-The Mercedes Benz Modification

12. 2)Transverse Muscle dividing
 In newborn and infants, this incision is preferred
bcs more abdominal exposure is gained per
lenght of incision than with vertical exposure
 Because infants’ abdomen longer transverse
than vertical girth.
 Also true of short, obese adult

13. 3)McBurney Incision(muscle
split)
 İncision of choice most
appendicectomies
 The level and lenght of incision
will vary according to thickness
of abd. wall and suspected
position of apendix.
 is made at the junction of
middle third and outer third of
a line running from umblicus to
anterior superior iliac
spine,McBurney point.
 Originally placed the incision
obliquely from above laterally
to below medially.
 Also used in left lower

15. 4)Oblique Muscle Cutting Incision
 Eponym of Rutherford-Morrison Incision
 Extension of McBurney incision by division of
oblique fossa
 Can be used for right and left sided colonic
resection, caecostomy or sigmoid colostomy

17. 5)Pfannenstiel Incision
 Used frequently by gynecologist 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.

18. 6)Maylard Transverse Muscle Cutting Incision
 gives excellent exposure to pelvic organ
 Skin incision is placed above but parallel to
traditional placement of Pfannenstiel incision

20.  Either right or left
 Converts pleural and peritoneal cavities into one
common cavity
 Thereby gives excellent exposure
 Right incision may be particularly useful in elective
and emergency hepatic resections
 Left incision may be used in resection of lower end
of esophagus and proximal portion of stomach.
 Incision is extended along line of 8th intercostal
space,the space immediately distal to inferior pole
of scapula.

21.  1. Askew, A.R. (1975) : The Fowler-Weir approach to
appendicectomy. British Journal of Surgery, 62(4): 303-4.
 2. Ayers, J.W., Morley, G.W. (1987): Surgical incision for caesarean
section. Obstetrics Gynaecology, 70(5): 706-8.
 3. Brand, E. (1991): The Cherney incision for gynaecologic cancer.
American Journal of Obstetrics and Gynaecology, 165(1): 235.
 4. Brennan, T.G., Jones, N.A., Guillou, P.J. (1987): Lateral
paramedian incision. British Journal of Surgery, 74(8): 736-7.
 5. Brodie. T.E., Jackson, J.T., McKinnon, W.M. (1976): A muscle
retracting subcostal incision for cholecystectomy. Surgery
Gynaecology Obstetrics 143(3): 452-3.
 6. Brooks, M.J., Bradbury, A., Wolfe, H.N. (1999) : Elective repair of
type IV thoraco-abdominal aortic aneurysms; experience of a
subcostal (transabdominal) approach. European Journal of Vascular
Endovascular Surgery, 18(4): 290-3.
 7. Burnand, K.G., Young, A.E.: The New Aird’s Companion in
Surgical Studies. Churchil Livingstone Edinburgh (1992).