IP: Pfannenstiel incision Midline incision or midline laparotomy — The most common incision for laparotomy is the midline incision, a vertical incision which follows the linea alba. Midline incisions are particularly favoured in diagnostic laparotomy, as they allow wide access to most of the abdominal cavity. The upper midline incision usually extends from the xiphoid process to the umbilicus. A typical lower midline incision is limited by the umbilicus superiorly and by the pubic symphysis inferiorly. Sometimes a single incision extending from xiphoid process to pubic symphysis is employed, especially in trauma surgery. Typically, a smooth curve is made around the umbilicus.

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A surgical incision is an aperture into the body to permit the work of the operation to proceed. The wound can be covered in a protective dressing and kept dry for a few days, before normal washing can resume.

Advise the patient should be advised to seek advice if any signs of infection or wound dehiscence. Lanz Incision and Gridiron Incision The Lanz and Gridiron incisions are two incisions that can be used to access the appendix, predominantly for appendicetomy. Midline Incision The midline incision no. The incision will cut through the skin, subcutaneous tissue, and fascia, the linea alba and tranversalis fascia, and the peritoneum before reaching the abdominal cavity.

As well as obtaining significant exposure of the viscera, this incision causes minimal blood loss or nerve damage, and can be used for emergency procedures. Its positioning however does make it susceptible to significant scars. Paramedian Incision The paramedian incision no. It was originally used to access much of the lateral viscera, such as the kidneys, the spleen, and the adrenal glands. The incision runs cm lateral to the midline, cutting through the skin, subcutaneous tissue, and the anterior rectus sheath.

The anterior rectus sheath is separated and moved laterally, before the excision is continued through the posterior rectus sheath if above the arcuate line and the transversalis fascia, reaching the peritoneum and abdominal cavity.

The incision will take a long time and is often technically difficult, however it does prevent any division of the rectus muscle and provides access to lateral structures.

Kocher Incision A Kocher incision no. The incision is made to run parallel to the costal margin, starting below the xiphoid and extending laterally. The incision will then pass through the all the rectus sheath and rectus muscle, internal oblique and transversus abdominus, before passing through the transversalis fascia and then peritoneum to enter the abdominal cavity.

Common instruments include the camera, cutting and dissecting scissors, and grippers. The port sites will vary depending on the surgery being performed, yet the umbilicus is nearly always utilised as a port site to allow the camera to pass through.


Abdominal Incisions in General Surgery

Midline Incision A midline abdominal incision can be used to access the abdominal cavity above or below the umbilicus. The incision is quick to perform and it results in minimal blood loss, owing to the avascular nature of the linea alba. The exposure of the abdomen as a whole is excellent. Extensions, when required, can easily be made superiorly or inferiorly, providing access to the whole abdominal cavity, including the retro-peritoneum. All these properties render the midline approach suitable for emergency and exploratory laparotomy of the abdominal cavity.


Surgical incision

Aram The anterior rectus sheath is separated and moved laterally, before the excision is continued through the posterior rectus sheath if above the arcuate line and the transversalis fascia, reaching the peritoneum and abdominal cavity. Two modifications and extensions of the Kocher incision are possible:. Transverse incisions crossing the midline are rarely performed Thoraco-abdominal oblique incisions Can be used for exploration of both peritoneal and pleural cavities. This information is intended for medical education, and does not create any doctor-patient relationship, and should not be used as a substitute for professional diagnosis and treatment. Further Reading Systematic review and meta-analysis of cutting diathermy versus scalpel for skin incision.

SAE - JA1012 PDF


Contributed by Mika Sinanan, MD and his staff at the University of Washington Medical School When the diagnosis of appendicitis is clear, the McBurney incision is one of two incisions used for appendectomy. This is the classic location of the appendix. Since the appendix is a mobile part of the body, it may be found in various places in the right lower quadrant. For best exposure, incision should be adapted after physical examination at the maximum point of tenderness.


Tips for Open Surgical Approach to Pelvis for Urologic Surgery


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