Transverse incisions

Question 1

Incidence of severe wound infection

Question 2

Pfannenstiel incision

Answer 2

• Curved incision is approximately 10–15 cm long
• 2 cm above the pubic symphysis
• The skin and rectus sheath are opened transversely using sharp dissection
• The rectus muscles are not cut and the fascia is dissected along the rectus muscles.

Question 3

Küstner incision

Answer 3

• Incorrectly referred to as modified Pfannenstiel incision
• Slightly curved skin incision beginning below the level of the anterior superior iliac spine and extending just below the pubic hairline
• The superficial branches of the inferior epigastric artery or vein may be encountered in the fat
• This incision is more time-consuming and extensibility is limited.

Question 4

Cherney incision

Answer 4

• Transection of the rectus muscles at their insertion on the pubic symphysis and retraction cephalad to improve exposure
• This can be used for urinary incontinence procedures to access the space of Retzius and to gain exposure to the pelvic side-wall for hypogastric artery ligation.

Question 5

Maylard incision

Answer 5

• Muscle-cutting incision, in which all layers of the lower abdominal wall are incised transversely approximately 3–8 cm above the symphysis
• The fascia is not dissected free of the rectus muscles. - The peritoneum is usually entered in a transverse fashion. In a patient with clinical evidence of impaired circulation in the lower extremity, a midline incision should be preferred to the Maylard incision, in view of the risk of lower extremity ischaemia secondary to inferior epigastric artery ligation.

Question 6

Mouchel incision

Answer 6

It runs at the upper limit of the pubic hair and is thus lower than the Maylard incision. The muscles are divided above the openings of the inguinal canals

Question 7

Joel-Cohen incision

Answer 7

• This is a straight transverse incision through the skin, 3 cm below the level of the anterior superior iliac spines
• Higher than Pfanneistiel
• The subcutaneous tissues and fascia are opened in the midline and extended laterally with blunt finger dissection. Blunt dissection is used to separate the rectus muscles vertically and then open the peritoneum