CREOG Surgical Curriculum Flashcards
What’s the difference between Pfannenstiel, Cherney, Maylard, Küstner, and Turner-Warwick’s incision?
Pfannenstiel’s incision: 2 to 5 cm above the pubic symphysis and usually is 10 to 15 cm in length. The upper and lower fascia are dissected off the underlying rectus muscle. The rectus abdominis muscle is separated along the midline.
Cherney’s incision: placed slightly lower on the abdomen compared to Pfannenstiel’s incision. The tendons of the rectus and pyramidalis muscles are incised at their insertion to the symphysis following blunt separation from the underlying bladder and adventitial tissue. A half-centimeter segment of tendon is left on the symphysis for reattachment.
Maylard’s incision: at the level of the anterior iliac spine, through all layers of the abdominal wall (aponeurosis, the deep inferior epigastric vessels, the rectus muscles)
Küstner’s incision: transverse skin incision at approximately 5 cm above the symphysis and just below the anterior iliac spine. Subcutaneous adipose is then separated from the rectus sheath in a VERTICAL plane to reveal the linea alba. A vertical midline incision is then made in the linea alba. The procedure for the midline incision is subsequently followed.
Turner-Warwick’s incision: centered 2 to 3 cm above the symphysis and placed within the lateral borders of the rectus muscles. The lower pole of the rectus muscles from below the symphysis are separated from the overlying sheath. The aponeurosis incision is usually 2 cm below the symphysis and 4 cm across. The rectus sheath incision is angled upward to the lateral border of the rectus but remains medial to the internal oblique and transversus abdominis muscle bellies. A Kocher clamp can be placed on the aponeurosis for traction as it is separated from the muscle by blunt and sharp dissection. The pyramidalis muscles usually remain attached to the aponeurosis. The rectus muscles are separated from the transversalis fascia, and the peritoneum is incised in the midline.
