Surgical Incisions

Stj.Dr. Aylin Mert

0902110019

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

Langers Line
Langers
Line
correspond
to the
natural
orientation
ofcollagen
fibers in
thedermis,
and are
generally
parallel to
the

Incisions
made
parallel to
Langer's
lines may
heal better
and produce
less scarring
than those
that cut
across.

Layer of Anterior Abdominal Wall

Skin
Subcutaneous tissue
Superficial Fascia
-Campers Fascia-fatty superficial layer
-Scarpas Fascia-deep fibrous layer
Deep Fascia(Gallaudets Fascia)
Musculoaponeurotic Layer
-External Oblique Muscle
-Internal Oblique Muscle
-Transverse Abdominal Muscle
-Rectus Abdominis-Pyramidalis Muscle
Fascia Transversalis
Preperitoneal Fatty Tissue
Peritoneum

Abdominal & Pelvic incisions

Vertical
Incisions

-Midline
-Paramedian

Transverse & Oblique

Incisions

-Kochler Subcostal Incision

-Transverse Muscle Dividing
-McBurney Incisions
-Oblique Muscle cutting
-Pfannenstiel Incision
-Maylard Incision

Abdominothoracic
Incisions

Vertical Incisions
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.

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.
is placed 2 to 5 cm
lateral to midline over
median aspect of
bulging transverse
convexity of rectus
muscle.

Vertical Incisions

Vertical Incisions
2)Paramedian Incision (contd)
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 doesnt give good access to contralateral
structures.

Transverse Incisions
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.
s 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
Especially used in
cholecystectomy

Transverse Incisions
1)Kocher Subcostal Incisions(contd)
is divided into :
-Chevron (Roof Top) Modification
-The Mercedes Benz Modification

Transverse Incisions

Transverse Incisions
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

Transverse Incisions
3)McBurney Incision(muscle
split)
ncision 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 quadrant to
deal with certain lesion of sigmoid
colon such as drainage of
diverticular abscess.

Transverse Incisions

Transverse Incisions
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

Transverse Incision

Transverse Incisions
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.

Transverse Incisions
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

Thoracoabdominal
Incisions

Thoracoabdominal
Incisions
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.

References:

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): 7367.
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):

Thank You