Abdominal incisions
- Abdominal incisions are based on anatomical principles
- They must allow adequate assess to the abdomen
- They should be capable of being extended if required
- Ideally muscle fibres should be split rather than cut
- Nerves should not be divided
- The rectus muscle has a segmental nerve supply
- It can be cut transversely without weakening a denervated segment
-
Above the umbilicus tendinous intersections prevent retraction of the
muscle
Midline incision
- Midline incisions are the commonest approach to the
abdomen
- The following structures are divided:
- Skin
- Linea alba
- Transversalis fascia
- Extraperitoneal fat
- Peritoneum
- The incision can be extended by cutting through or
around the umbilicus
- Above the umbilicus the Falciform ligament should
be avoided
- The bladder can be accessed via an extraperitoneal
approach through the space of Retzius
- The wound can be closed using a mass closure
technique
- The most popular sutures are either non-absorbable
or absorbable monofilaments
- At least 1 cm bits should be taken 1 cm apart
- Requires the use of one or more sutures four times the wound length
Paramedian incision
- A paramedian incision is made parallel to and
approximately 3 cm from the midline
- The incision transverse:
- Skin
- Anterior rectus sheath
- Rectus - retracted laterally
- Posterior rectus sheath - above the arcuate line
- Transversalis fascia
- Extraperitoneal fat
- Peritoneum
- The potential advantages of this incision are:
- The rectus muscle is not divided
- The incisions in the anterior and posterior
rectus sheath are separated by muscle
- The incision is closed in layers
- Takes longer to make and close
- Had a lower incidence of incisional hernia (when sutures were not so
good)
Bibliography
Burger J W, van't Riet M, Jeekel J. Abdominal
incisions: technique and postoperative complications. Scan
J Surg 2002; 91: 351-321. |