Abdominal incisions

medicine ; precise info ; personally made

1. Misbah Azher 13901039 Abdominal Incisions

2. An incision is a fine cut made by a surgeon during surgery. Abdominal incision -> Incision on abdominal wall

3. Classification of incisions

4. 1.Midline Incisions- A vertical incision which follows the linea alba. It may be: - upper midline incision -lower midline incision -single incision Vertical Incisions

5. 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 Disadvantages- -Cosmetically not approved Used in surgeries like  Like in perforated appendix, twisted ovarian cyst, ileal perforation.

6. 2. Para median Incision- It is made 2 to 5 cm lateral to umbilicus.

7. Advantages- - vertical incision to right or left,provi des 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 Disadvantages- - 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. -The incision is laborious and difficult to extend superiorly as is limited by costal margins. -It doesn’t give good access to contralateral structures. - Comparatively more bleeding

8. Advantages: - best cosmetic results - less painful -faster healing postoperative - greater strength Disadvantages: -more time-consuming -more haemorrhagic - compromised ability to explore upper abdominal cavity - division of multiple layers of fascia and muscle and nerves, may result with haematoma or seroma in potential spaces. Transverse Incision

9. I s started at midline ,2 to 5 cm below the xiphoid,and extends downward s outwards and para llel to and about 2.5 cm below costal margin - It affords excellent exposure to gall bladder and biliary tract and can be made on left side to afford access to spleen . - Especially used in cholecystectomy 1. Kochlar’s subcoastal Incision

10. is divided into : -Chevron (Roof Top) Modification -Rooftop incision used for gastrectomy, oesophagectomy, pancreatectomy, hepatic resection, and liver transplantation. -The Mercedes Benz Modification -bilateral Kochlar incision with extension upto xphisternum ,classically used for liver transplantation , diaphragmatic hiatuses.

11. 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 2)Transverse Muscle dividing

12. Incision is made at the McBurney point. Originally placed the incision obliquely from above laterally to below medially. I ncision of choice most appendicectomies Similar incision can a lso used in left lower quadrant to deal with certain lesion of sigmoid colon such as drainage of diverticular abscess 3)McBurney Incision(muscle split)

13. It is a variation of mcburneys incision that is made the same point but in transverse plane. It gives cosmetically good scar. Lanz Incision

14. 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 4)Oblique Muscle Cutting Incision

15. 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 5)Pfannenstiel Incision

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

17. Thoraco-Abdominal 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 .

18. Thoraco - abdominal Incision

19. Kochlar Median Mc-Burney Battle Lanz Para-Median Transverse Muscle Cutting Oblique Muscle Cutting Pfannenstiel