Surgical incision (Physiotherapy) (General Surgical Incision)

1. Types of Surgical incision General Surgical Condition (Physiotherapy) Physio Pedia

2. Type of surgery (Elective/Emergency). • Target organ. • Previous surgery. • Grade of patient obesity. • Surgeon own experience and preference. Choice of incision Physio Pedia

3. Vertical incisions • Midline • Paramedian • Transverse incisions • Transverse Muscle Dividing • Pfannenstiel incision • Mayland incision • Oblique incisions • Kocher subcostal incision • Mc Burney incision • Oblique Muscle Cutting • Inguinal incision Common Abdominal & Pelvic incision Physio Pedia

4. Vertical incision which follows the Linea alba. It may be:- • Upper Midline incision • Lower Midline incision • Single incision • It is Favored in diagnostic laparotomy, as it allows wide access to abdominal cavity. Midline incision Physio Pedia

5. Advantages Disadvantages Care need to be taken just above the umbilicus where the falciform ligament. Midline scar. Bladder injury. Incisional hernia. Adhesion in lower incision. (Contd.) • 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 length of abdomen. • Supine position. Physio Pedia

6. Placed 2 to 5 cm lateral to midline it can be extended from costal margin to pubis. 2. Para Median incision Physio Pedia

7. Advantage Disadvantage Time consuming. Bleeding and hematoma. Incision needs to be closed in layer. Difficulty extension superiorly as limited by the costal margin . Tends to strip the muscle of their lateral blood and nerve supply resulting in atrophy of the muscle medial to the incision. (Contd.) • Provides access to lateral structure. • Avoid injury to nerves, limit trauma to rectus muscles. • Permits good restoration of abdominal wall function. • Can be extended by slanting the upper end of the incision medially toward the xiphoid process if required. Physio Pedia

8. This incision is made just above the umbilicus dividing one or both of the rectus muscle. • It is useful for:- • Right or left colon. • Duodenum. • Pancreas. • Subhepatic space. 3. Transverse incision Physio Pedia

9. Advantage Disadvantage Limited lateral access in comparison with midline incision that can then be extended. More wound infections compared to midline thought to be due to greater difficulty in controlling bleeding and hematoma formation. (Contd.) • Less pain than a midline incision. • Good access to midline upper GI structure. • Transverse incision cause the least amount of damage. • As the recti have a segmental nerve supply, it can be cut transversely without weakening a denervated segment. • Muscular segments can be rejoined. • Better scar and good healing. Physio Pedia

10. Used frequently by gynecologist and urologist for access to pelvic organ, bladder, prostate and for C-Section. • A convex 5 cm to 12 cm incision, located the suprapubic skin crease about 2 cm to 5 cm above the pubic symphysis. 4. Pfannenstiel incision Physio Pedia

11. Gives excellent exposure to pelvic organ. • Skin Incision is placed above but parallel to traditional placement of Pfannenstiel incision. 5. Mayland Transverse (muscle cutting Incision) Physio Pedia

12. It affords excellent exposure to gallbladder and biliary tract and can be made on left side to afford access to spleen. • Is started at midline, 2 to 5 cm below the xiphoid and extends downward, outwards and parallel to and about 2.5 cm below costal margin. 6. Kocher (Subcostal) Incision Physio Pedia

13. Consist of bilateral low Kocher's incision with upper midline incision up the xiphi sternum. • Gives excellent access to the upper abdominal viscera mainly the diaphragmatic hiatuses. 6.A. Mercedes Benz Modification Physio Pedia

14. They convert the pleural and peritoneal cavities into one. • They allow good access to the lungs, liver and spleen. • Incision is extended along line of 8th intercostal space. 7. Thoraco- abdominal incision (Right/ Left) Physio Pedia

15. It commences 1.25 cm below and lateral to renal angle and passes towards the anterior superior iliac spine. 8. Flank incision (Retroperitone-al approach) Physio Pedia

16. Is made at the junction of middle third and outer-third of a line running from umbilicus to, anterior superior iliac spine. 9. Mc. Burney point Physio Pedia

17. It is variation of Mc. Burney incision that is made the same point but in transverse plane. • It gives cosmetically good scar. 10. Lanz Incision Physio Pedia

18. Oblique muscle cutting incision extension of mc. Burney incision by division of oblique fossa. • Can be used for:- • Right/ Left sided colonic resection. • cecostomy. • Sigmoid colostomy. 11. Rutherford- Morrison incision Physio Pedia

19. Done for:- • Inguinal hernia • Testicular cancer • Cryptorchidism • Hydrocele • Varicocele • UDT • Orchiectomy 12. Inguinal incision Physio Pedia