Surgery scars

Question 1

Flank (oblique) incision

Answer 1

In flank, for lungs, liver, spleen.

Question 2

Midline incision

Answer 2

From xiphoid to umbilicus.

Layers: skin, fascia (camper’s and scarpa’s), linea alba, transversalis fascia, extraperitoneal fat and peritoneum.

Question 3

Paramedian incision

Answer 3

2-5cm lateral to midline, for kidney, adrenal and spleen.

Layers: skin, fascia (camper’s and scarpa’s) and the anterior rectus sheath

Question 4

Pfannenstiel incision

Answer 4

Suprapubic skin crease, for C-section incision, lower GI or UT.
Layers: skin, fascia, anterior rectus sheath, rectus muscle, transversalis fascia, extraperitoneal fat, perineum.

Question 5

Roof top incision (Chevron modification)

Answer 5

Bilateral subcostal incisions meeting at xiphoid process, for oesphagus, stomach, kidneys, adrenal, liver and Whipple’s procedure.

Question 6

Transverse incision

Answer 6

Transeverse cut, for right or left colon, duodenum, pancreas, subhepatic space.
Layers: skin, fascia, anterior rectus sheath, rectus muscle (+/- internal oblique, depending on the length of the incision), transversus abdominus, transversalis fascia, extraperitoneal fat and peritoneum

Question 7

Subcostal incision (Kocher’s incision)

Answer 7

Below costal margin, for gallbladder and biliary tract, spleen.
Layers: Skin, rectus sheath, rectus muscle, internal oblique, trasnversus abdominus, transversalis fascia, extraperitoneal fat and peritoneum.

Question 8

McBurney’s incision

Answer 8

At McBurney’s point, for appendiectomies.
Layers: skin, fascia, internal oblique medially and external oblique laterally, transversus abdominus, transversalis fascia, extraperitoneal fat and peritoneum.