Anatomy Surgical incision

1 anatomy

1.1 head , neck
1.2 chest
1.3 abdomen , pelvis
1.4 eye

anatomy

incisions of neck, chest, , abdomen. incisions of neck, chest, , abdomen. key follows:

a. carotid incision

b. thyroidectomy incision

c. tracheotomy incision

d. subclaviculor incision

e. sternotomy incision

f. infraareolar incision (either side)

g. inframamary incision (either side)

h. clamshell incision

i. kocher / subcostal incision

j. mercedes benz incision

k. paramedian incision (either side)

l. chevron incision

m. epigastrin / upper midline incision

o. mcburney s / gridiron incision (left side - appendectomy)

p. rockey-davis / lanz incision (left side - appendectomy)

q. supraumbilical incision

r. infraumbilical incision

s. pararectus incision

t. mayland incision

u. pfannenstial / kerr / pubic incision

v. gibson incision (either side, conventionally left)

w. midline incision

x. inguinal incision

y. femoral incision

z. turner-warwick s incision

surgical incisions planned based on expected extent of exposure needed specific operation planned. within each region of body, several incisions common.

head , neck

wilde s incision – post-aural incision used variant mastoiditis drainage, , named after sir william wilde, ent surgeon in dublin first described @ end of nineteenth century. son, oscar wilde s, death stated doctors due meningitis stemming ear infection. had had operation, believed mastoidectomy.

chest

median sternotomy – primary incision used cardiac procedures. extends sternal notch xiphoid process. sternum divided, , finochietto retractor used keep incision open.
thoracotomy – division of ribs side of chest.

abdomen , pelvis


incisions used caesarean section

is: supra-umbilical incision

im: median incision

im: maylard incision

ip: pfannenstiel incision



midline incision or midline laparotomy – common incision laparotomy midline incision, vertical incision follows linea alba. midline incisions particularly favoured in diagnostic laparotomy, allow wide access of abdominal cavity.

the upper midline incision extends xiphoid process umbilicus.
a typical lower midline incision limited umbilicus superiorly , pubic symphysis inferiorly.
sometimes single incision extending xiphoid process pubic symphysis employed, in trauma surgery. typically, smooth curve made around umbilicus.


pfannenstiel incision, kerr incision, or pfannenstiel-kerr incision lower transverse incision made in lower segment of uterus below umbilicus , above pubic symphysis. commonly used in caesarian section , abdominal hysterectomy benign disease. in classic pfannenstiel incision, skin , subcutaneous tissue incised transversally, linea alba opened vertically.
chevron incision – incision cut made on abdomen below rib cage. cut starts under mid-axillary line below ribs on right side of abdomen , continues way across abdomen opposite mid-axillary line thereby whole width of abdomen cut provide access liver. average length of incision approximately 24 30 inches.
cherney incision – cherney described transverse incision allows excellent surgical exposure space of retzius , pelvic sidewall. curvilinear skin , rectus fascial incision made 2 finger breadths above symphysis pubis , carried in langer s lines 2 fingerbreadths medial 1 anterior superior iliac spine corresponding position medial opposite anterior superior iliac spine. anterior rectus fascia mobilized distally off underlying rectus muscle bodies. pyramidalis muscles dissected free , sharply excised expose underlying rectus tendons. index finger, plane developed between fibrous tendons of rectus muscle , underlying transversalis fascia. using sharp no.10 scalpel blade, rectus tendons transected transversely 1–2 cm distal superior edge of pubic bone. rectus muscle should never cut. rectus muscles retracted , peritoneum opened.the inferior epigastric vessels may need division. closure accomplished 5 6 horizontal mattress sutures of permanent braided suture approximating anterior rectus tendons intact distal anterior rectus fascia. continuous monofilament suture closure of lateral edges of rectus muscle anterior rectus fascia prevents hernia. patients should wear binder @ least 2 weeks. no incision provides wider pelvic exposure, , relatively painless compared midline incisions. result pleasing cosmetic result of abdominal incision.
kocher’s incision – oblique incision made in right upper quadrant of abdomen, classically used open cholecystectomy. named after emil theodor kocher. appropriate operations on liver, gallbladder , biliary tract. shares name kocher incision used thyroid surgery: transverse, curved incision 2 cm above sternoclavicular joints;
kustner’s incision – transverse incision made 5 cm above symphysis pubis below anterior iliac spine. subcutaneous tissue separated in midline , linea alba exposed. vertical midline incision made through linea alba. care taken control , ligate branches of superficial epigastric vessels. step of incision time consuming , 1 of limitations associated. type of incision offers little extensibility , less exposure pfannestiel incision.
lanz incision – variation of traditional mc burney s incision, made @ mcburney s point on abdomen: lanz incision made @ same point along transverse plane , deemed cosmetically better. typically used perform open appendectomy. variations exist on method used locate incision. surgeons advocate incision made approximately 2 cm below umbilicus centered on mid clavicular-midinguinal line. others imply use of mcburney s point center incision (1/3rd of distance anterior superior iliac spine umbilicus).
maylard incision – variation of pfannenstiel incision maylard incision in rectus abdominis muscles sectioned transversally permit wider access pelvis. maylard incision called mackenrodt incision. incision in rectus muscles performed of cautery, scalpel or surgical stapler. important identify inferior epigastric vessels on lateral surface of these muscles , ensure isolation , ligation if incision span more half rectus muscle width. advisable not separate rectus muscles anterior rectus sheath prevent retraction, in turn facilitates closure @ end of procedure. among complications associated type of incision delayed bleeding cut edges of rectus muscles deep epigastric vessels. furthermore, depending on patient s body habitus, incision may not offer adequate exposure upper abdomen.
mcburney incision / gridiron s incision– described in 1894 mcburney, used appendectomy. oblique incision made in right lower quadrant of abdomen, classically used appendectomy. incision placed perpendicular spinoumblical line @ mcburney s point, i.e. @ junction of lateral one-third , medial two-third of spino-umblical line. incision used open appendectomy, begins 2 5 centimeters above anterior superior iliac spine , continues point one-third of way umbilicus (mcburney s point). thus, incision parallel external oblique muscle of abdomen allows muscle split in direction of fibers, decreasing healing times , scar tissue formation. incision heals rapidly , has cosmetic results, if subcuticular suture used close skin.
mcevedy s incision – mcevedy s original incision lateral paramedian incision used incise rectus sheath along lateral margin , gain access pulling rectus medially. incision became obsolete because of high incisional hernia rate. modification introduced nyhus used transverse (oblique) skin incision 3 cm above inguinal ligament , transverse incision (oblique) divide anterior rectus sheath. rectus muscle pulled medially. modification prevented high incisional hernia rate.
turner-warwick s incision – type of incision placed 2 cm above symphysis pubis , within lateral borders of rectus muscles. sheath overlying rectus muscles @ symphysis pubis released, 4 cm transversely, , incision angled lateral borders of rectus muscles. lateral edges of incisions remain medial internal oblique muscles. sheath may released off aponeurosis of traction applied using kocker clamps. pyramidalis muscles typically left attached aponeurosis. rectus muscles separated , incision made in midline. type of incision exposure of retropubic space offers limited access upper pelvis , abdomen.

eye

mini asymmetric radial keratotomy – used in eye surgery cure keratoconus , correct astigmatism. consists of series of microincisions of variable depth, length between 1.75 , 2.25 millimeters, made diamond knife, designed cause controlled scarring of cornea, changes thickness , shape.
radial keratotomy – used in eye surgery: corneal microincisions made flatten cornea , correct myopia.




^ surgical incisions – anatomical basis section: thoracic incisions: http://medind.nic.in/jae/t01/i2/jaet01i2p170.pdf
^ vitale, salvatore giovanni; marilli, ilaria; cignini, pietro; padula, francesco; d’emidio, laura; mangiafico, lucia; rapisarda, agnese maria chiara; gulino, ferdinando antonio; cianci, stefano (2014). comparison between modified misgav-ladach , pfannenstiel-kerr techniques cesarean section: review of literature . journal of prenatal medicine. 8 (3-4): 36–41. issn 1971-3282. pmc 4510561 . pmid 26265999. 
^ synd/2500 @ 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.
^ fischer, josef. mastery of surgery. wolters kluwer health. retrieved 15 december 2016. 
^ giacalone pl, daures jp, vignal j, herisson c, hedon b, laffargue f (2002). pfannenstiel versus maylard incision cesarean delivery: randomized controlled trial . obstetrics , gynecology. 99 (5 pt 1): 745–50. doi:10.1016/s0029-7844(02)01957-9. pmid 11978282. 
^ surgical incisions – anatomical basis: http://medind.nic.in/jae/t01/i2/jaet01i2p170.pdf