Abdominal Incisions in General Surgery Flashcards
What are the most commonly used incisions in abdo surgery?
Lanz incision
Midline incision
What are the key principles of making a surgical incision?
Follow Langer’s lines where possibe to allowe for maximal wound strength and minimal scarring
Muscles should be split not cut if possible.
What are Langer’s lines?
Also called skin tension lines which reflect internal tension within the skin and are mainly produced by the connective tissue of the dermis, superimposed by external tension.
Aligning a surgical incision or excision with skin tension lines results in minimal tension across the closure of the defect. This leads to optimal scar formation and minimises wound contraction.
What are surgical excisions closed by?
Sutures
Staples
Steri-strips
Tissue glue
or a combo
Post-op management
Might be covered in a protective dressing to be kept dry for a few days
Post-op abx might be warranted as well.
Non-absorbable sutures or staples must be removed as well.
Explain Lanz Incision
A transverse incision used in order to perform an appendicectomy.
It is made at McBurney’s point and involve going through all of the abdo muscles, transversalis fascia + peritoneum.
What other incision might be used to access the appendix?
Gridiron incision
Explain Gridiron incision
An oblique incision used in order to perform an appendicectomy.
It is made at McBurney’s point and involve going through all of the abdo muscles, transversalis fascia + peritoneum.
Which is usually preferred, Lanz or Gridiron?
Lanz because it follows Langer’s lines
What is a midline incision used for?
A wide array of abdominal surgery as it gives access to majority of the abdominal organs.
Explain midline incision
A midline laparotomy can run anywhere from xiphoid process to the pubic symphysis and pass around the umbilicus.
It cuts through the skin, subcut, fascia, linea alba, transversalis fascia and peritoneum and then reaches the cavity.
Advantages of midline incision.
Gives a good exposure to the viscera
Minimal blood loss and nerve damage
Used commonly in emergency procedures
-ve -> the positioning will leave a significant scar.
Explain paramedian incision.
Not commonly used in the UK, but was originally used to access much of the lateral viscera like kidneys, spleen and adrenal galnds.
2-5 cm incision lateral to the midline
You cut through skin, subcut and anterior rectus sheath.
The anterior sheath is then separated and moved laterally.
Then excision continues with going through the posterior rectus sheath and the transversalis fascia.
Why is paramedian incision suboptimal?
Because it takes a long time and is often technically difficult.
It can also damage the muscles’ lateral blood and nerve supply and cause atrophy of the muscle.
It does however prevent any division of the rectus muscle.
What is Kocher incision used for?
A subcostal incision used to gain access for gall bladder and biliary tree.
Explain Mercedes Benz incision
Is the chevron incision with a vertical incision and break through the xiphisternum.
Classically seen in liver transplantions.
