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

Last updated: 03 January 2010

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