Common Surgical Incisions
David Rassam
Deciding the right type of surgical incision is extremely important.
The ideal incision allows:
 Ease of access to the desired structures
 Can be extended if needed
 Ideally muscles should be split rather than cut
 Heals quickly with minimal scarring
 Aesthetically pleasing
Incisions should be placed as far as possible from stoma sites in order to avoid
interfering with the stoma site and causing complications such as retraction and
prolapse of the stoma.
Surgical incisions on the abdomen can be divided into transverse, vertical and
oblique incisions.
1. Kocher’s incision – a RUQ incision made for open cholecystectomy
2. Midline incision – virtually all abdominal procedures may be performed
through this incision. It can extend from the xiphoid process to just above
the umbilicus and can be continued to below the umbilicus by curving the
incision around the umbilicus.
3. McBurney incision – Used for appendectomies. McBurney’s point = two
thirds from the umbilicus and a third from the right anterior superior iliac
spine.
4. Battle incision – Used for appendectomies.
5. Lanz incision – More commonly used for appendectomies. This leaves a
more aesthetically pleasing scar hidden in the bikini line.
6. Paramedian incision – allows access to lateral structures such as the
kidneys, adrenals and spleen. This can be extended to curve towards from
xiphoid process, a Mayo-Robson incision.
7. Transverse incision – allows access to right or left colon, duodenum,
pancreas and subhepatic space.
8. Rutherford Morrison incision – this is an extension of the McBurney
incision. Used for right or left sided colonic resection, caecostomy or
sigmoid colostomy.
9. Pfannenstiel incision – suprapubic. Allows exploration of the lower GI
and UT, as well as the pelvic reproductive organs. Commonly used for Csections or abdominal hysterectomy.
10. Thoracoabdominal incision – LUQ or RUQ. They convert the pleural and
peritoneal cavities into one. Allows good access to live, lungs and spleen.
Left incision can also provide good access to the stomach and oesophagus.
11. Laproscopic incisions - small cuts in the skin made in the abdominal
wall to allow the instruments of laparoscopy access to the contents of the
abdominal cavity.
House-keeping:
Surgical incisions may be closed with sutures, staples, steri-strips or local tissue
glue.
It is important to keep the wound site clean and incisions are often covered with
a protective dressing. Patients are encouraged to keep the wound as dry as
possible to limit wound infection. Showering and bathing can resume after a
couple of days. Wounds that are closed with non-absorbable sutures and staples
require removal of these materials first.
While gentle exercise is encouraged, it is important to avoid pressure, pulling
and stretching on wounds.
As wounds heal, it is common for patients to see their wounds becoming itchy,
red, swollen and wounds may even ooze sero-sangiunous fluid. These all
represent the healing process. It is important to know what is normal so that
abnormalities in wound healing that may represent infection, wound dehiscence,
hypertrophic and keloid scars may be detected.
Further reading:
http://www.fastbleep.com/biology-notes/8/8/37
http://medind.nic.in/jae/t01/i2/jaet01i2p170.pdf