Pancreas and the problem Surgical Abdominal Incisions Definitions Incision: A cut produced surgically by a sharp instrument that

creates an opening into an organ or space in the body. Abdomen: The part of the trunk that lies between the thorax and the pelvis Incision selection - Accessibility - Extensibility - Security Note: The incision must not only give ready and direct access to the anatomy to be investigated but also provide sufficient room for the operation to be performed. The incision should be extensible in a direction that will allow for any probable enlargement of the scope of the operation, but it should interfere as little as possible with the functions of the abdominal wall. In the planning of an abdominal incision, the following factors must be taken into consideration : Preoperative diagnosis The speed with which the operation needs to be performed, as in trauma or major haemorrhage. Previous abdominal operation. The incision must be tailored to the patients need but is strongly influenced by the surgeons preference. In general, re-entry into the abdominal cavity is best done through the previous laparotomy incision. This minimizes further loss of tensile strength of the abdominal wall by avoiding the creation of additional fascial defects It is probably no exaggeration to state that, in abdominal surgery, wisely chosen incisions and correct methods of making and closing such wounds are factors of great importance. Any mistake, such as a badly placed incision, inept methods of suturing, or illjudged selection of suture material, may result in serious complications such as haematoma formation, an ugly scar, an incisional hernia, or, worst of all, complete disruption of the wound

Layers of abdominal wall Skin (- Langers lines. Superficial fascia (Campers fascia (Fatty Layer) & Scarpa's fascia (Membranous Layer) Deep fascia (Connective Tissue Layer.) Muscles (Anterior group (Rectus abdominis & pyramidalis) & lateral group (External Oblique, internal oblique & transverses) Transversalis fascia Extraperitoneal fascia Peritoneum RECTUS ABDOMINIS Origin: Symphasis pubis, pubic crest Insertion: 5th, 6th and 7th costal cartilage and xiphoid process. Nerve Supply: Lower six thoracic nerves. Rectus Sheath: made up of the aponeuroses of the three anterolateral abdominal muscles as they converge at the linea alba. Linea Alba: fusion of the aponeuroses of the abdominal muscles, and it separates the left and right rectus abdominis muscles. External Oblique Origin: lower 8 ribs. Insertion: Xiphoid process, Linea alba, pubic crest, pubic tubercle, iliac crest. Nerve Supply: Lower six thoracic nerves, iliohypgastric n., ilioinguinal n. Internal Oblique Origin: Lumbar Fascia, iliac crest, lateral two thirds of inguinal ligament. Insertion: Lower three ribs, costal cartilage, Xiphoid process, Linea alba, symphasis pubis. Nerve Supply: Lower six thoracic nerves, iliohypgastric n., ilioinguinal n. Transversus Abdominis

Origin: lower six costal cartilage, lumbar fascia, anterior two thirds of iliac crest, lateral third of inguinal ligament. Insertion: Xiphoid process, Linea alba, symphasis pubis. Nerve Supply: Lower six thoracic nerves, iliohypgastric n., ilioinguinal n.