Abdominal Surgical Incisions

Question 1

Lanz and Gridiron incision
Location
Uses
Benefits

Answer 1

Both made at McBurney’s point for appendicetomy

• Lanz => transverse, more aesthetically pleasing due to continuation with Langer lines
• Gridiron => oblique, parallel to inguinal ligament

Question 2

Midline incision
Location
Uses
Benefits and drawbacks

Answer 2

From xiphoid to pubic symphysis, around umbilicus

• significant exposure of viscera => variety of uses
• minimal blood loss
• minimal nerve damage

-susceptible to significant scars

Question 3

Paramedian incision
Location
Uses
Benefits and drawbacks

Answer 3

Rarely used, lateral to the midline
Through rectus sheath

• access to lateral viscera (kidneys, spleen, adrenals)
• prevents divison of rectus muscle
• time consuming, technically difficult
• lateral blood, nerve supply may be damaged => atrophy of muscle medial to incision

Question 4

Kocher incision
Modifications and extensions
Location
Uses
Benefits and drawbacks

Answer 4

Parallel to costal margin from xiphoid, runs laterally to the right

• access to gall bladder, biliary tree
• good exposure to viscera, heal well

Modifications
Chevron/rooftop => extension to left
-access to esophagus, stomach, both adrenals, liver

Mercedes Benz => chevron + vertical incision up sternum
-same uses as chevron, commonly used in liver transplants

-open procedure => risk of infection

Question 5

Left kidney transplant scar

Implications on examination

Answer 5

Normally on left
Old kidney remains
Transplanted kidney is more anterior

Question 6

Tiny scars that heal well

-what is it a sign of

Answer 6

Laparoscopic surgery