Abdominal Incisions
Dr. Ajun Patel , MPT. DNHE
Assistant Prnfessor
• 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
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
• lncision should extensible
Principles
• Least interference with the function of the
abdOniinal wall
• Insert DT through a separate incision
• Close the wound layer by layer
Classification
O Vertical incision
O Transverse incision
Oblique incision
O Others
Vertical incision
H MEDIAN
Supra-umbilical
Infra-umbilical
H PARA-MEDIAN
Upper
(Rt/Lt)
Lower
(Rt/Lt)
O OBLIQUE
Mc Burney's
k Kocher (sub costal)
F Sii’ Rutherford
F Postrolateral
H TRANS VERSE
Lanz
k
Pfaiinensteil's k
Mid abdominal
fi Rt.upper
May lard Transverse
Classification Accoi dllig to thc muscle
Median
No muscle divided Para median
Pararectal
Through linea semilunaris
Muscle splitting Para median
Lateral
Muscle dividing
Transi'ectal
Supei'ior
Middle
Infer ior
VERTICAL INCISIONS
1. MEDIAN INCISIONS
4 Supra—umbilical
k Infra-umbilical
Supra umbilica{
Intro umbilical
• SIGNI FICANCE-it is favoured In diagnostic liiparotomy,
as it allows wide access to abdominal Cavity.
Supra umbilical- stomach.dtiodenuiii,gall bladder, liver,
bilc duct, and paiici'eas
k Infra umbil ical- intestine, appendix. urinary bladder,
prostate, rupture and ectopic Pi‘egnancy
Mid lines - small and large bowel
Ad antaacs
• Quick and good access for emergency surgery
• Almost bloodless
• Very quick to make as well as to close
• No muscle fibers are divided
• No nervcs are injured
• Good access to upper abdominal viscera and both
side of abd. Can be reached
• Can be cxtended full length of abdomen curving
around umbilical scar.
• Supra umbilical part heals wcll aS it is thick,
strOng, and hold suture well
Disadvantage
• Healing in infratiinblical region is bad as linea alba
is thin and weak there for complication of burst
abdomen and incision hernia
• lnjury to the falciform ligament
• Midline scar
• Bladder injury
Vertical incisions(cont.)
2. PARA-MEDIAN
• Upper(Rt/Lt)
• Lower(Rt/Lt)
•Placed 2 to 5 cm lateral to iuidline over median
aspect of bulging transvcrse convexity of rectus
musclc
•Rectus retracted I inch from the midline on either side
Rt.upper parainedian
stomach, duodenum, gallbladder, head of pancreas and
Rt. lobe of liver
Lt.upper paraniedian
oesophagus. cardia of stomach, spleen, left lobe of
liver
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
Advantage
• Access and extend up and down
• Provides access to lateral structures
• Closei’ is secure specially in muscle i'ctractiiig type as
Inuscle comes over it
• Less chances of incisional hernia
Disadv a image
• Cosiiietically bad
• Tension
• Hernia
• More blood loss
• More time consuming
• Other quadrant accessibility is less
Para rectal (Battle's incision)
• Median to outer border of rectus muscle
•Muscle retracted medially
Features
• Perpendicular to midline 1/3 of spino umbilical
• 1/3 above and 2/3 below the line
Acccss
• Appendix
•Pe1vic with extension
•Colon with extension
• Rectus muscle is not cut
• Good healing
• Damage to Nerve supply rectus cause muscle atrophy
• Accessibility limited
• Hernia
Ti‘ansverse incisions
1. Upper(suitcase incisions) or Chevron
(rooftop) modification
• The incision may be continued across the niidline into
double kocher's incision or rooftop appearance which
provide excellent acccss to upper abdomen particularly
in those with bi oad costal margin
• Here both recti ai'e ctit transversely
• Uses-
• Total gastrectoiny
• Total oesopliagectOiny
• Extensive hepatic resection
• Bilateral adreiiectomy
Transverse incisions(cont.)
2. Lower (Pfannenstiel incision)
• 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.
3. Mallard Transverse Muscle Cutting Incision
•Gives excellent exposure to pelvic organ
•Skin incision is placed above but parallel to
traditional placement of pfanncnsticl incision
Trans ersc i14ClSlOl4S.(COl4l.)
4. Lanz incision
•It is a variation of McBiimcys incisiOn that is
made the same point but iii tiansverse plane.
•It gives cosinetically good scar
Modified McBurney
(ak Lan2
Rutherford
extension
Transverse incisions(cont.)
5. Transverse Muscle dividing(mid abdomen)
•lii newborn and infants, this incision is preferred
bcs more abdominal exposure is gained per
length of incision than with vertical cxposorc
•Because infants abdomen longei ti'ansverse than
vertical girth.
•Also ti tie of short, obese adult
Oblique incisions
1. Kochers/ sub-costal incisions
• It affords excellent exposure to gall bladder and
biliary tract and can be made on left side to afford
access to spleen.
•Obliqtie 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 ciii long
• Access—
• Lt.spleen and Rt,livcr, gall bladder
•Good exposuie to livei and gall
bladder(cholecystectoiiiy)
• Muscle and nerve cutting - chances of hernia
Oblique incisions(cont.)
2. Mc-bumey incision
• Perpendiculai 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,
Adu aiitiiae d isacl› .statuie
• Mtiscle splittiiig — no post opeiative liernia
• No dairage to miiscle and nerve
• Dircct approach tO appcndix
• Abdoinen can not be exploi‘ed
• Ditficulty in dealing with appendix which is not
easily found
Some other incisions
Oblique Muscle Cutting
Incision
Extension of McBumey
incision by division of
oblique fossa
Can be used for right and
left sided colonic resection,
or sigmoid colostomy
• Consists of bilateral low kocher’s incision with
upper inidline incision upto the
xiphisternum.
• Provides excellent access to the upper abdominal
viscera mainly the diaphragmatic liiatuses
Thoracic incisions(cont.)
1. MEDIAN STERNOTOMY
”thoracic incisions(cont)
2.POSTERO-LATERAL INCISION
•This follows the Veurebral
border of scapiila And the line
of rib (numbers 5,6,7, or 8)
to the AnteriOr angle or
costal mai gin
ANTERO-LATERAL INCISIONS
• This start close to the midline in front, follows
along the line of thG rib below the breast to the
posterior axillary line.
SO E OTHER NC S ONS
Poster1or Anterior
cervical tnc\s1on cervical \ncfsTon
Posterior Anterior
lumbar inctsion lumbar tnc\
sfon
‘ '- "
4
COMMON GYNAECOLOGICAL
INCISIONS
INCISION FOR
MASTECTOMY
NAME THE NUMBERS...
ANSWERS
• 1 Kocher
• 2 Midline
• 3 McBurney
•4 Baftle
• 6 Para rąedion
• 7 Transverse
• 9 P{onnenstiel
