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J. Anat. Soc. India 50(2) 170-178 (2001)

J Anat. Soc. India 50(2) 170-178 (2001)

Surgical Incisions—Their Anatomical Basis

Part IV-Abdomen

*Patnaik, V.V.G.; **Singla, Rajan K.; ***Bansal V.K..

Department of Anatomy, Government Medical College, *Patiala, **Amritsar, ***Department of Surgery, Govt. Medical College &

Hospital, Chandigarh, INDIA.

Abstract. The present paper is a continuation of the previous ones by Patnaik et al 2000 a, b & 2001. Here the anatomical basis of

the various incisions used in anterior abdominal wall their advantages & disadvantages are discussed. An attempt has been made to add

the latest modifications in a concised manner.

Key words : Surgical Incisions, Abdomen, Midline, Paramedian, McBurney, Gridison, Kocher.

Introduction :

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 (Nygaard and

Squatrito, 1996). 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

(Pollock, 1981; Carlson et al, 1995).

Before the advent of minimally invasive

techniques, optimal access could only be achieved

at the expense of large high morbidity incisions.

Endoscopic and laparoscopic technology has,

however revolutionized these concepts facilitating

patient friendly access to even the most remote of

abdominal organs (Maclntyre, 1994).

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 (Zinner et al, 1997):

1. Accessibility

2. Extensibility

3. Security

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 (Velanovich, 1989). 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. The surgical

incision and the resultant wound represent a major

part of the morbidity of the abdominal surgery.

Planning of an abdominal incision :

In the planning of an abdominal incision,

Nyhus & Baker (1992) stressed that the following

factors must be taken into consideration (a) preoperative diagnosis (b) the speed with which the

operation needs to be performed, as in trauma or

major haemorrhage, (c) the habitus of the patient,

(d) previous abdominal operation, (e) potential

placements of stomas (Funt, 1981; Telfer et al,

1993). Ideally, the incision should be made in the

direction of the lines of cleavage in the skin so that

a hairline scar is produced.

The incision must be tailored to the patients

need but is strongly influenced by the surgeon’s

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 (Fry & Osler,

1991).

Care must be taken to avoid ‘tramline’ or

‘acute angle’ incisions (Figure 1), which could lead

to devascularisation of tissues. It is also helpful if

incisions are kept as far as possible from

established or proposed stoma sites and these171

J. Anat. Soc. India 50(2) 170-178 (2001)

Classification of incisions :

The incisions used for exploring the abdominal

cavity can be classified as :

(A) Vertical incision : These may be

(i) Midline incision

(ii) Paramedian incisions

(B) Transverse and oblique incisions :

(i) Kocher's subcostal Incision

(a) Chevron (Roof top

Modification)

(b) Mercedes Benz Modification

(ii) Transverse Muscle dividing incision

(iii) Mc Burney’s Grid iron or muscle

spliting incision

(iv) Oblique Muscle cutting incision

(v) Pfannenstiel incision

(vi) Maylard Transverse Muscle cutting

Incision

(C) Abdominothoracic incisions

A. Vertical incisions :

Vertical incisions include the midline incision,

paramedian incision, and the Mayo-Robson

extension of the paramedian incision.

(i) Midline Incision (Figure 2) :

Almost all operations in the abdomen and

retroperitoneum can be performed through this

universally acceptable incision (Guillou et al, 1980).

Advantages (a) It is almost bloodless, (b) no muscle

fibres are divided, (c) no nerves are injured, (d) it

affords goods access to the upper abdominal

viscera, (e) It is very quick to make as well as to

close; it is unsurpassed when speed is essential

(Clarke, 1989) (f) a midline epigastric incision also

can be extended the full length of the abdomen

curving around the umbilical scar (Denehy et al,

(1998).

In the upper abdomen, the incision is made in

the midline extending from the area of xiphoid and

ending immediately above the umbilicus (Ellis,

1984). Skin, fat, linea alba and peritoneum are

divided in that order. Division of the peritoneum is

best performed at the lower end of the incision, just

above the umbilicus so that falciform ligament can

(a) (b)

Fig. 1. (a) Tramline Incision. (b) Acute angle incision.

stomas should be marked preoperatively with skin

marking pencils to avoid any mistakes (Burnand &

Young, 1992).

Cosmetic end results of any incision in the

body are most important from patients’ point of view.

Consideration should be given wherever possible, to

siting the incisions in natural skin creases or along

Langer’s lines. Good cosmesis helps patient morale.

Much of the decision about the direction of the

incision depends on the shape of the abdominal

wall. A short, stocky person sometimes has a longer

incision and frequently better exposure, if the

incision is transverse. A tall, thin, asthenic patient

has a short incision if it is made transversally,

whereas a vertical incision affords optimal exposure

(Greenall et al, 1980).

Certain operations are ideally done through a

transverse or subcostal incision, for example

cholecystectomy through a right Kocher’s incision,

right hemicolectomy through an infraumbilical

transverse incision, and splenectomy through a left

subcostal incision. Vagotomy and antrectomy can be

done through a bilateral subcostal incision with a

longer right and shorter left extension if the patient

is stocky or obese (Grantcharov & Rosenberg,

2001).

Certain incisions, popular in the past, have

been abandoned, and appropriately so. One

example of this is the para-rectus incision made at

the lateral border of the rectus sheath. This incision

was used until the mid 1940 primarily for the

removal of the gall bladder, the spleen, and the left

colon. It denervates the rectus muscle and produces

an ideal environment for the development of

postoperative ventral hernia, and has absolutely

nothing to recommend it (Nyhus & Baker, 1992).

Patnaik, V.V.G., et al172

J. Anat. Soc. India 50(2) 170-178 (2001)

be seen and avoided. If necessary for exposure, the

ligament can be divided between clamps and

ligated. A few centimeters of upwards extension can

be gained by extending the incision to either side of

the xiphoid process, or actually excising the xiphoid

(Didolkar & Vickers, 1995). The extraperitoneal fat is

abundant and vascular in this area, and small

vessels here need to be coagulated with diathermy.

The infraumbilical midline incision also divides

the linea alba. Because the linea alba is

anatomically narrow at the inferior portion of the

abdominal wall, the rectus sheath may be opened

unintentionally, although this is of no consequence.

In the lower abdomen, the peritoneum should be

opened in the uppermost area to avoid possible

injury to the bladder.

It is a good practice to place a bladder catheter

before any surgery on the lower abdomen and to

curve the properitoneal and peritoneal incisions

laterally when approaching the pubic symphysis to

avoid entry into the bladder (Nyhus & Baker, 1992).

Special care is needed when operating on

patients with intestinal obstruction or when reexploring following previous abdominal surgery (Fry

& Osler, 1991). In intestinal obstruction, distended

bowel loops may be there immediately below the

incision and in re-exploration, the bowel may be

adherent to the peritoneum. The way to avoid this is

to open the peritoneum in a virgin area at the upper

or lower part of the incision (Levrant et al, 1994).

(ii) Paramedian Incision (Figure 3)

The paramedian incision has two theoretical

advantages. The first is that it offsets the vertical

incision to the right or left, providing access to the

lateral structures such as the spleen or the kidney.

The second advantage is that closure is theoretically

more secure because the rectus muscle can act as

a buttress between the reapproximated posterior

and anterior fascial planes (Cox et al, 1986).

Fig. 2. Midline Incision

Fig. 3. Paramedian Incisions

The skin incision is placed 2 to 5 cm lateral to

the midline over the medial aspect of the bulging

transverse convexity of the rectus muscle. Extra

access can be obtained by sloping the upper

extremity of the incision upwards to the xiphoid

(Didolkar et al, 1995).

Skin and subcutaneous fat are divided along

the length of the wound. The anterior rectus sheath

is exposed and incised, and its medial edge is

grasped and lifted up with haemostats. The medial

portion of the rectus sheath then is dissected from

the rectus muscle, to which the anterior sheath

adheres. Segmental blood vessels encountered

during the dissection should be coagulated. Once

the rectus muscle is free of the anterior sheath it

can be retracted laterally because the posterior

sheath is not adherent to the rectus muscle. The

posterior sheath and the peritoneum which are

adherent to each other, are excised vertically in the

same plane as the anterior fascial plane (Brennan et

al, 1987). The deep inferior epigastric vessels are

encountered below the umbilicus and require

ligation and division if they course medially along

the line of the incision (Chuter et al, 1992).

A paramedian incision below the umbilicus is

made in a similar manner. The only difference is

that inferior epigastric vessels are exposed in the

posterior compartment of the rectus sheath and the

transversalis fascia is found in the anterior fascial

Surgical Incisions-Abdomen173

J. Anat. Soc. India 50(2) 170-178 (2001)

layer below the semicircular line of Douglas.

some surgeons still prefer to split the rectus

muscle rather than dissect it free (Guillou et al,

1980). In this rectus-splitting technique, the muscle

is split longitudinally near its medial border (medial

1/3rd or preferably one-sixth), after which posterior

layer of the rectus sheath and peritoneum are

opened in the same line. This incision can be made

and closed quickly and is particularly valuable in

reopening the scar of a previous paramedian

incision. In such circumstances, it is very difficult, or

indeed impossible to dissect the rectus muscle away

from the rectus sheath.

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

margin.

3. It doesn’t give good access to

contralateral structures.

The Mayo-Robson extension of the

paramedian incision is accomplished by curving the

skin incision towards the xiphoid process. Incision of

the fascial planes is continued in the same direction

to obtain a larger fascial opening (Pollock, 1981).

(B) Transverse Incisions (Figure 4)

Transverse incisions include the Kocher

subcostal incision, transverse muscle dividing,

McBurney, Pfannenstiel, and Maylard incisions.

(i) Kocher subcostal incision (Figure 5)

Theodore Kocher originally described the

subcostal incision; it affords excellent exposure to

the gall bladder and biliary tract and can be made

on the left side to afford access to the spleen

(Kocher, 1903). It is of particular value in obese and

muscular patients and has considerable merit if

diagnosis is known and surgery planned in advance.

Fig. 4. Transverse and transverse-oblique

Incisions. A. Kocher incision. B. Transverse

Incision. C. Rockey-Davis incision. D. Maylard

incision. E. Pfannenstiel incision

Fig. 5. Kocher’s Incision

The subcostal incision is started at the midline,

2 to 5 cm below the xiphoid and extends

downwards, outwards and parallel to and about 2.5

cm below the costal margin (Hardy 1993; Dorfman

et al, 1997). Extension across the midline and down

the other costal margin may be used to provide

generous exposure of the upper abdominal viscera.

The rectus sheath is incised in the same direction as

the skin incision, and the rectus muscle is divided

with cautery; the internal oblique and transversus

abdominis muscles are divided with cautery. Some

authors have described the retraction of rectus

muscle instead of dividing it (Brodie et al, 1976; Fink

& Budd, 1984).

Special attention is needed for control of the

branches of the superior epigastric vessels, which

lie posterior to and under the lateral portion of the

rectus muscle. The small eighth thoracic nerve will

almost invariably be divided; the large ninth nerve

must be seen and preserved to prevent weakening

of the abdominal musculature. The incision is

deepened to open the peritoneum (Dorfman et al,

1997).

In the recent years, many surgeons have

advocated the use of a small 5-10 cm incision in the

subcostal area for cholecystectomy - mini-lap

Patnaik, V.V.G., et al174

J. Anat. Soc. India 50(2) 170-178 (2001)

because the incision passes between adjacent

nerves without injuring them. The rectus muscle has

a segmental nerve supply, so there is no risk of a

transverse incision depriving the distal part of the

rectus muscle of its innervation. Healing of the scar,

in effect, simply results in the formation of a man

made additional fibrous intersection in the muscle

(Pemberton and Manaz, 1971).

(ii) Transverse Muscle-dividing incision (Figure 6)

The operative technique used to make such an

incision is similar to that for the Kocher incision. In

newborns and infants, this incision is preferred,

because more abdominal exposure is gained per

length of the incision than with vertical exposure

because the infant’s abdomen has a longer

transverse than vertical girth (Gauderer, 1981). This

is also true of short, obese adults, in whom

transverse incision often affords a better exposure.

(iii) McBurney Grid iron or Muscle-split incision

(Figure 7)

The McBurney incision, first described in 1894

by Charles McBurney is the incision of choice for

most appendicectomies (McBurney, 1894). The

level and the length of the incision will vary

according to the thickness of the abdominal wall and

the suspected position of the appendix (Jelenko &

Davis 1973; Watts & Perrone, 1997). Good healing

and cosmetic appearance are virtually always

achieved with a negligible risk of wound disruption

or herniation.

cholecystectomy (Seenu & Misra, 1994). This

incision is similar to the Kocher’s incision except for

the length of the incision. The major advantages of

this incision are lesser postoperative pain, early

recovery from the surgery and return to work and

good cosmetic results (Coelho et al, 1993). But

diadvantage is less exposure, which can be

dangerous in cases of difficult anatomy or lot of

adhesions and chances of injury to bile ducts or

other structures (Kopelman et al, 1994; Gupta et al,

1994).

(a) Chevron (Roof Top) Modification :

The incision may be continued across the

midline into a double Kocher incision or roof top

approach (Chevron Incision) (Figure 6), which

provides excellent access to the upper abdomen

particularly in those with a broad costal margin

(Chute et al, 1968; Brooks et al, 1999). This is

useful in carrying out total gastrectomy, operations

for renovascular hypertension, total

oesophagectomy, liver transplantation, extensive

hepatic resections, and bilateral adrenalectomy etc

(Chino & Thomas, 1985; Pinson et al, 1995;

Miyazaki et al, 2001).

Fig. 6. A.. A: Rooftop incision; B..: Mercedes Benz extension

(b) The Mercedes Benz Modification :(Fig. 6)

Variant of this incision consists of bilateral low

Kocher’s incision with an upper midline limb up to

and through the xiphisternum (Sato et al, 2000).

This gives excellent access to the upper abdominal

viscera and, in particular to all the diaphragmatic

hiatuses (Yoshinaga, 1969; Motsay et al, 1973;

Brooks et al, 1999).

The rectus muscle can be divided transversely.

Its anterior and posterior sheaths are closed without

any serious weakening of the abdominal muscle

Classically, the McBurney incision is made at

the junction of the middle third and outer thirds of a

Fig. 7. Surface markings of the right iliac fossa

appendicectomy incision. A. The Classic McBurney incision

is obnliquely placed. B. Most surgeons today use a more

transverse skin-crease incision

Surgical Incisions-Abdomen175

J. Anat. Soc. India 50(2) 170-178 (2001)

line running from the umbilicus to the anterior

superior iliac spine, the McBurney point (Watts,

1991). However, if palpation reveals a mass, the

incision can be placed directly over the mass.

McBurney originally placed the incision obliquely,

from above laterally to below medially. However, the

skin incision can be placed in a skin crease

transversely [Rockey-Davis Incision (Fig 4c) or Lanz

Incision or Bikini Incision], which provides a better

cosmetic result (Delany & Carnevale, 1976;

Pleterski & Temple, 1990). Otherwise, the two

incisions are similar.

If it is anticipated that it may be necessary to

extend the incision, then the incision should be

placed obliquely, which enables it to be extended

laterally as a muscle splitting incision (Losanoff &

Kjossev, 1999).

After the skin and subcutaneous tissue are

divided, the external oblique aponeurosis is divided

in the direction of its fibres; exposing the underlying

internal oblique muscle. A small incision is then

made in this muscle adjacent to the outer border of

the rectus sheath. The opening is enlarged to permit

introduction of two index fingers between the muscle

fibres so that internal oblique and transversus can

be retracted with a minimal amount of damage. The

peritoneum is then grasped with a thumb forceps,

elevated and opened.

If further access is required, the wound can be

easily enlarged by dividing the anterior sheath of the

rectus muscle in line with the incision, after which

rectus muscle is retracted medially (Jelenko &

Davis, 1973; Moneer, 1998). Wide lateral extension

of the incision can be affected by combination of

division and splitting of the oblique muscles along

the line of their fibres in the lateral direction (Weir

extension) (Askew, 1975).

This incision also may be used in the left lower

quadrant to deal with certain lesions of the sigmoid

colon, such as drainage of a diverticular abscess.

The ilioinguinal and iliohypogastric nerves

cross the incision for appendectomy and their

accidental injury should be prevented which can

predispose the patient to inguinal hernia formation in

the postoperative period (Mandelkow & Loeweneck,

1988).

(iv) Oblique Muscle-cutting incision

This incision bears the eponym of the

Rutherford-Morrison incision (Talwar et al, 1997).

This is extension of the McBurney incision by

division of the oblique fossa and can be used for a

right or left sided colonic resection, caecostomy or

sigmoid colostomy.

(v) Pfannenstiel incision (Figure 4)

The Pfannenstiel incision is used frequently by

gynaecologists and urologists for access to the

pelvis organs, bladder, prostate and for caesarean

section (Ayers & Morley, 1987; Mendez et al, 1999;

Hendrix et al, 2000). The skin incision is usally 12

cm long and is made in a skin fold approximately 5

cm above symphysis pubis. The incision is

deepened through fat and superficial fascia to

expose both anterior rectus sheaths, which are

divided along the entire length of the incision. The

sheath is then separated widely, above and below

from the underlying rectus muscle. It is necessary to

separate the aponeurosis in an upward direction,

almost to the umbilicus and downwards to the pubis.

The rectus muscles are then retracted laterally and

the peritoneum opened vertically in the midline, with

care being taken not to injure the bladder at the

lower end.

The incision offers excellent cosmetic results

because the scar is almost always hidden by the

patient’s pubic hair postoperatively (Griffiths, 1976).

Because the exposure is limited this incision should

be used only when surgery is planned on the pelvic

organs (Mendez et al, 1999).

(vi) Maylard Transverse Muscle Cutting Incision

(Figure 4)

Many surgeons prefer this incision because it

gives excellent exposure of the pelvic organs

(Helmkamp & Kreb, 1990; Brand, 1991). The skin

incision is placed above but parallel to the traditional

placement of Pfannenstiel incision. The rectus

fascia and muscle are then cut transversely, and the

incision is continued laterally as far as necessary,

dividing external and internal oblique muscles; the

transverses abdominis and transversalis fascia are

opened in the direction of their fibres.

Patnaik, V.V.G., et al176

J. Anat. Soc. India 50(2) 170-178 (2001)

(C) Thoracoabdominal Incision (Figures 8 & 9)

The thoracoabdominal incision, either right or

left, converts the pleural and peritoneal cavities into

one common cavity and thereby gives excellent

exposure. Laparotomy incisions, whether upper

midline, upper paramedian or upper oblique can be

easily extended into either the right or left chest for

better exposure (Nyhus & Baker, 1992).

The right incision may be particularly useful in

elective and emergency hepatic resections (Kise et

al, 1997). The left incision may be used effectively

in resection of the lower end of the esophagus and

proximal portion of the stomach (Molina et al, 1982;

Ti, 2000).

When liver resection is anticipated, it is now

more common to give a sternum splitting incision

than to extending it into the right pleural space (Sato

et al, 2000). The reasons for this are that the

sternum heals with considerably less pain than does

the costochondral junction; the exposure is as good,

and the intrapericardial vena cava can be controlled

through this incision if there is untoward venous

bleeding (Miyazaki et al, 2001).

The thoracic incision is carried down through

the subcutaneous fat and the lattismus dorsi,

serratus anterior and external oblique muscles. The

intercostals muscles are divided with cautery and

pleural cavity is opened and lung allowed to

collapse. The incision is continued across the costal

margin, and the cartilage is divided in a V shape

manner with a scalpel so that the two ends

interdigitate and can be closed more securely. A

chest retractor is inserted and opened to produce

wide spreading of the intercostal space. After

ligation of the phrenic vessels in the line of the

incision, the diaphragm is divided radially (Zinner et

al, 1997).

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37. Levrant, S.G., Bieber, E., Barnes, R. (1994): Risk of anterior

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38. Losanoff, J.E., Kjossev, K.T. (1999): Extension of

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39. Mandelkow, H., Leoweneck, H. (1988): The iliohypogastric

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Surgical Incisions-Abdomen

http://medind.nic.in/jae/t01/i2/jaet01i2p170.pdf

In surgical practice, deciding on the right type of surgical access for a specific condition would be a skill of its own for

a surgeon. The decision to select a specific incision would depend on the several elements. These would be,

Problem site Related anatomical structures Easy access Less complications Quicker healing Minimum scar

But, at instances, all these options might not be fulfilled and the surgeons have to make a professional judgment as to

decide on what's best for the patients' condition and act fast in order to save the life of the patient.

Out of many areas in the body, abdomen could be one area which sees many surgical incisions for different kinds of

surgical necessities. This article will discuss predominantly on abdominal incisions and its uses in surgical practice.

1. Grid iron incisions

Also known as 'McBurneys incision', the incision is the most commonly used incision for 'appendicectomy'. The

incision will be placed at the McBurney's point which is at the junction between the middle one third and the outer one

third of a line extending from umbilicus towards the anterior superior iliac spine. It's commonly places obliquely and

has the potential to be expended in case the need arise.

2. Pfannansteil incision

The incision is the usual procedure adopted for surgical access towards pelvic organs and mainly for cesarean

sections. The incision is placed horizontally about 5 cm above the pubic symphysis and is about 12 cm in length.

3. Kocher subcostal incision

The incision is placed below the costal margin or the lower margin of the rib cage and could be on either left or in the

right. But, most often the incision will be placed on the right side of the body to gain access to the gall bladder and the

billiary tree.

4. Mid line incision

The incision placed on the middle of the abdomen will run vertically and will give the surgeon enough access to

almost all abdominal organs and will facilitate good visualization as well. There are several advantages of this kind of

incision and being blood less plain is one of the most important. This incision is widely used in surgeries related to

bowel pathologies and especially in situations which require the necessity to remove part of the bowel.

Paramedian incisions are also used when the need arise to access certain organs towards a particular site.

Cheveron incision and Mercedes Benz Modifications are some of the other incisions which will allow the surgeons

better access to upper abdominal organs.

Apart from these, it is vital to remember that a surgeon will be able to make a decision based on his clinical

experience on the placement of the incision as well as the required size of the incision. Therefore, the art of doing a

surgery would not be limited to text book patterns of incisions, but you can be assured that the above described

incisions will account for many of these decisions

http://www.helium.com/items/1635785-common-types-of-surgical-incisions

List of Surgical Incisions

Some of the more famous surgical incisions are:

[edit]Agnew's incision

An incision used to release pus in the lacrimal sac in acute phlegmonous dacryocystitis. It is named after Cornelius Rea Agnew

[edit]Alexander incision

[edit]Auvray incision

[edit]Bar’s incision

[edit]Battle incision

 a paramedian incision through the anterior and posterior rectus sheaths with medial retraction of the intact rectus abdominis.Associated persons:William Henry Battle

Description:Incision used in operation for appendicitis. Vertical incision of the abdominal wall with temporary retraction of the rectus muscle medially.

[edit] Bardenheuer's curved incision

Associated persons:Bernhard Bardenheuer

Description:

Semi-circular incision of the skin just above the submammary fold for opening of mamma in severe mastitis. The resulting scar is practically invisible.

[edit]Bergmann’s incision

[edit]Bevan’s incision

vertical incision parallel to outer border of rectus muscle; used for access to upper abdominal quadrants.

[edit]Cherney incision

Suprapubic, transverse incision of rectus muscles off pubic bone; used to gain access to reproductive organs in women. Technique originally described as using bilateral ligation of inferior epigastric vessels to allow greater incision width; provides excellent access to Retzius space and pelvic sidewall.

[edit]Chernez incision

[edit]Chevron incision

 a bilateral subcostal incision in the abdomen, in the shape of an inverted “V”; used in upper abdominal procedures. This is useful in carrying out total gastrectomy, operations for renovascular hypertension, total oesophagectomy, liver transplantation, extensive hepatic resections, and bilateral adrenalectomy etc

[edit]Circular incision

[edit]Clute incision

[edit]Deaver’s incision

an incision in the right lower abdominal quadrant, with medial displacement of the rectus muscle

[edit]Dührsen incision

[edit]Fergusson’s incision

An incision used in maxillectomy, along the junction of cheek and nose, to bisect the upper lip.Resection of maxilla; uses incision running along border of nose and cheek and around ala to midline and bisects upper lip.

[edit]Fowler’s incision

[edit]Girdiron's incision

An oblique incision made in the right lower quadrant of the abdomen, classically used for appendectomy

[edit]Graefe incision

(1) removal of cataract by a limbal incision with capsulotomy and iridectomy. Both operations were landmarks in the field of ophthalmic   surgery ; (2) iridectomy for glaucoma.Technique for removing cataract and lens by laceration of capsule and iridectomy; approach via incision in sclera.

[edit]Heerman’s incision

[edit]Hartmann incision

resection of a diseased portion of the colon, with the proximal end of the colon brought out as a colostomy and the distal stump or rectum being closed by suture.

[edit]Kerr incision

A low transverse incision in C-sections, preferred as there is less blood lost during surgery, less risk of rupture in future pregnancies, less postoperative infections and it is easier to repair.

[edit]Kocher’s incision

An oblique incision made in the right upper quadrant of the abdomen, classially used for open cholecystectomy. Named after Emil

Theodor Kocher. It is ppropriate for certain operations on the liver, gallbladder and biliary tract.[1][2] This shares a name with the

Kocher incision used for thyroid surgery: a transverse, slightly curved incision about 2 cm above the sternoclavicular joints;

[edit]Kustner’s incision

Similar to Pfannenstiel incision; uses slightly transverse incision beginning just below anterior iliac spine on each side and runs to just below pubic hairline. Fascia is incised through midline (unlike transverse fascial incision in Pfannenstiel), rectus muscles are retracted laterally, and peritoneum is opened in midline.

[edit]Langenbeck’s incision

[edit]LaRoque’s incision

[edit]Lynch’s incision

[edit]Mac Arthur's incision

[edit]Marylard incision

A variation of Pfannenstiel incision is the Maylard incision in which the rectus abdominis muscles are sectioned transversally to

permit wider access to the pelvis.[3]

[edit]McBurney incision

This is the incision used for open appendectomy, it begins 2 to 5 centimeters above the anterior superior iliac spine and continues to

a point one-third of the way to the umbilicus (McBurney's point). Thus, the incision is parallel to the external oblique muscle of the

abdomen which allows the muscle to be split in the direction of it's fibers, decreasing healing times and scar tissue formation. This

incision heals rapidly and generally has good cosmetic results, especially if a subcuticular suture is used to close the skin.[4]

[edit]Median sternotomy

This is the primary incision used for cardiac procedures. It extends from the sternal notch to the xiphoid process. The sternum is

divided, and a finochietto retractor used to keep the incision open. [5]

[edit]Midline incision

The most common incision for laparotomy is the midline incision, a vertical incision which follows the linea alba.

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.

Midline incisions are particularly favoured in diagnostic laparotomy, as they allow wide access to most of the abdominal cavity.

[edit]Mackenrodt incision

A transverse, semilunar incision in the abdomen.

[edit]Parker's incision

[edit]Perthes' incision

Associated persons:Georg Clemens Perthes

Description:A surgical incision for exposure of organs in the right upper abdominal quadrant.

[edit]Péan's incision

[edit]Pfannanstiel’s incision

The Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis.[6][7] In the classic

Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba is opened vertically. It is the

incision of choice for Cesarean section and for abdominalhysterectomy for benign disease.

[edit]Rocky-Davis’ incision

The Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for appendectomy.

Oblique Muscle-cutting incision

This incision bears the eponym of the Rutherford-Morrison incision. This is extension of the McBurney incision by division of the oblique fossa and can be used for a right or left sided colonic resection, caecostomy or sigmoid colostomy.

[edit]Schuchardt’s incision

A paravaginal rectal displacement incision, a surgical technique of making the upper vagina accessible for fistula closureor radical surgery via the vagina.

[edit]Shambaugh incision

[edit]Yorke-Mason’s incision

[edit]Warren incision

Skin incision tracing thoracomammary fold.

[edit]Wilde's incision

1.1   Agnew's incision

1.2   Alexander incision

1.3   Auvray incision

1.4   Bar’s incision

1.5   Battle incision

1.6   Bardenheuer incision

1.7   Bergmann’s incision

1.8   Bevan’s incision

1.9   Cherney incision

1.10   Chernez incision

1.11   Chevron incision

1.12   Circular incision

1.13   Clute incision

1.14   Deaver’s incision

1.15   Dührsen incision

1.16   Fergusson’s incision

1.17   Fowler’s incision

1.18   Girdiron's incision

1.19   Graefe incision

1.20   Heerman’s incision

1.21   Hartmann incision

1.22   Kehr’s incision

1.23   Kocher’s incision

1.24   Kustner’s incision

1.25   Langenbeck’s incision

1.26   LaRoque’s incision

1.27   Lynch’s incision

1.28   Mac Arthur's incision

1.29   Marylard incision

1.30   McBurney incision

1.31   Median sternotomy

1.32   Midline incision

1.33   Mackenrodt incision

1.34   Parker's incision

1.35   Perthes' incision

1.36   Péan's incision

1.37   Pfannanstiel’s incision

1.38   Rocky-Davis’ incision

1.39   Schuchardt’s incision

1.40   Shambaugh incision

1.41   Yorke-Mason’s incision

1.42   Warren incision

1.43   Wilde's incision