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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 ascpects e.g. surgical site, related anatomical structures, easy access, fewer complications, quicker healing and 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.
List of Surgical Incisions
Some of the more famous surgical incisions are:
An incision used to release pus in the lacrimal sac in acute phlegmonous dacryocystitis. It is named after Cornelius Rea Agnew
Cherney described a transverse incision that allows excellent surgical exposure to the space of Retzius and the pelvic sidewall. The skin and fascia are cut in a manner similar to a Maylard incision. The rectus muscles are separated to the pubis symphysis and separated from the pyramidalis muscles. A plane is developed between the fibrous tendons of the rectus muscle and the underlying transversalis fascia. Using electrocautery, the rectus tendons are cut from the pubic bone. The rectus muscles are retracted and the peritoneum opened.
This incision a cut is made on the abdomen below the rib cage. The cut starts under the mid-axillary line below the ribs on the right side of the abdomen and continues all the way across the abdomen to the opposite mid-axillary line thereby the whole width of the abdomen is cut to provide access to the liver. The average length of the incision is approximately 24 to 30 inches.
Gridiron's incision(Mc Burney's incision)
Descibed in 1894 by McBurney, used for appendectomy. An oblique incision made in the right lower quadrant of the abdomen, classically used for appendectomy Incision is placed perpendicular to the spinoumblical line at Mc Burney's point, i.e. at the junction of lateral one-third and medial two-third of spino-umblical line.
An oblique incision made in the right upper quadrant of the abdomen, classially used for open cholecystectomy. Named after Emil Theodor Kocher. It is appropriate for certain operations on the liver, gallbladder and biliary tract. This shares a name with the Kocher incision used for thyroid surgery: a transverse, slightly curved incision about 2 cm above the sternoclavicular joints;
A transverse incision is made 5 cms above the symphisys pubis but below the anterior iliac spine. The subcutaneous tissue is then separated in the midline and the linea alba is exposed. A vertical midline incision is made through the linea alba. Care is taken to control and ligate any branches of the superficial epigastric vessels. This step of the incision is usually time consuming and is one of the limitations associated. This type of incision offers little extensibility and less exposure than a Pfannestiel incision.
cosmetically better, used for open appendicectomy. is made approximately 2 cm below the umbilicus centered on mid clavicular-midinguinal line .
Mac Arthur's incision
also known as McBurney's incision
This is another name for the Maylard 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. The Maylard incision is also called the Mackenrodt incision. The incision in the rectus muscles is performed with the help of cautery, scalpel or surgical stapler. It is important to identify the inferior epigastric vessels on the lateral surface of these muscles and ensure their isolation and ligation if the incision will span more than half the rectus muscle width. It is advisable not to separate the rectus muscles from the anterior rectus sheath to prevent their retraction, which in turn facilitates closure at the end of the procedure. Among the complications associated with this type of incision is delayed bleeding from the cut edges of the rectus muscles as well as the deep epigastric vessels. Furthermore depending on the patient's body habitus, this incision may not offer adequate exposure to the upper abdomen.
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 its 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.
McEvedy's original incision was a lateral paramedian incision which used to incise the rectus sheath along its lateral margin and gain access by pulling the rectus medially. This incision became obsolete because of very high incisional hernia rate. A modification was introduced by Nyhus which used a transverse (oblique) skin incision 3 cm above the inguinal ligament and a transverse incision (oblique) to divide the anterior rectus sheath. The rectus muscle was then pulled medially. This modification prevented the high incisional hernia rate.
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.
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.
Used in eye surgery to cure keratoconus and correct astigmatism. It consists of a series of microincisions of variable depth, with a length between 1.75 and 2.25 millimeters, always made with a diamond knife, designed to cause a controlled scarring of the cornea, which changes its thickness and shape.
The Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis. 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 Caesarean section and for abdominal hysterectomy for benign disease.
The Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for appendectomy.
This type of incision is placed 2 cms above the symphysis pubis and within the lateral borders of the rectus muscles. The sheath overlying the rectus muscles at the symphysis pubis is released, 4 cms transversely, and the incision angled up to the lateral borders of the rectus muscles. The lateral edges of the incisions remain medial to the internal oblique muscles. The sheath may be released off the aponeurosis with the help of traction applied using Kocker clamps. The pyramidalis muscles are typically left attached to the aponeurosis. The rectus muscles are separated and the incision is made in the midline. This type of incision is good for exposure of the retropubic space but offers limited access to the upper pelvis and abdomen.
This incision is used for a variant mastoiditis drainage and incredibly was named after the father of Oscar Wilde who was an ENT surgeon at the end of the nineteenth century in Dublin and who first described it. This is a post-aural incision.
- synd/1010 at Who Named It?
- "Incisions". Archived from the original on 2007-11-01. Retrieved 2007-11-22.
- Giacalone PL, Daures JP, Vignal J, Herisson C, Hedon B, Laffargue F (2002). "Pfannenstiel versus Maylard incision for cesarean delivery: A randomized controlled trial". Obstetrics and gynecology 99 (5 Pt 1): 745–50. doi:10.1016/S0029-7844(02)01957-9. PMID 11978282.
- Surgical Incisions - Their Anatomical Basis: http://medind.nic.in/jae/t01/i2/jaet01i2p170.pdf
- Surgical Incisions - Their Anatomical Basis Section: Thoracic Incisions: http://medind.nic.in/jae/t01/i2/jaet01i2p170.pdf
- synd/2500 at Who Named It?
- H. J. Pfannenstiel. Ueber die Vortheile des suprasymphysären Fascienquerschnitts für die gynäkologischen Koeliotomien. (Volkmann’s) Sammlung klinischer Vorträge, Leipzig, 1900, n F. 268 (Gynäk. Nr. 97), 1735-1756.
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