Surgical Incisions Overview

Surgical Incisions Notes

Importance of Knowing Operative Incisions

  • For the Circulating Nurse:

    • Understand the extent and area to be prepared for surgery.
    • Prepare necessary gadgets for positioning the patient.

  • For the Scrub Nurse:

    • Guide in draping the operative site.
    • Ensure correct instruments and supplies are available.
    • Assist the surgeon effectively and efficiently.

Layers of the Abdomen

  • Skin: The outermost layer that provides protection.
  • Subcutaneous Tissue: Fatty tissue that insulates and cushions the body.
  • Fascia: Connective tissue that surrounds muscles and organs.
  • Muscle: Provides structure and movement.
  • Peritoneum: A serous membrane lining the abdominal cavity.

Regions of Abdominal Area

  • Right Hypochondriac Region
  • Epigastric Region
  • Left Hypochondriac Region
  • Right Lumbar Region
  • Umbilical Region
  • Left Lumbar Region
  • Right Iliac Region
  • Left Iliac Region

Types of Abdominal Incisions

  1. Paramedian Incision

    • Vertical incision about 4 cm lateral to the midline in the upper/lower abdomen.
    • Allows quick entry into the abdominal cavity.

  2. Longitudinal Midline Incision

    • Begins in epigastrium at xiphoid and can extend to the suprapubic region.
    • Used for various abdominal surgeries.

  3. Upper Longitudinal Midline Incision

    • Starts at the xiphoid process and goes down to the umbilicus.
    • Uses: Rapid control of bleeding ulcers, gastric surgery, exploratory laparotomy.

  4. Lower Longitudinal Midline Incision

    • Extends from the umbilical area down towards the suprapubic region.
    • Uses: Pelvic laparotomy, hysterectomy, cesarean section.

  5. Subcostal (Kocher’s) Incision

    • Oblique incision starting at the epigastrium, extending below the costal margin.
    • Provides good access to upper abdominal organs.

  6. Chevron Incision

    • Bilateral modified subcostal incision for liver transplantation or resections.

  7. McBurney’s Incision

    • Oblique incision at McBurney’s point (junction of the external and middle third between R iliac spine and umbilicus).
    • Primarily used for appendectomy.

  8. Mid-abdominal Transverse Incision

    • Horizontal incision in the mid-abdomen, extends slightly into the flank.
    • Uses: Choledochojejunostomy, transverse colostomy.

  9. Pfannenstiel’s Incision (Bikini incision)

    • Curved transverse incision across the lower abdomen.
    • Used in abdominal hysterectomy.

  10. Inguinal Incision (Gridiron Incision)

    • Oblique incision in the inguinal region.
    • Used for inguinal operations.

Other Incisions

  • Sternal Incision: For cardiac operations.
  • Thoracotomy Incisions:
    • Anterolateral: for lung and heart operations.
    • Posterolateral: for lung operations.
  • Collar Incision: Used in thyroidectomy.
  • Coronal (butterfly) Incision: For craniotomy.
  • Elliptical (Halsted) Incision: For radical mastectomy.
  • Limbal Incision: For cataract extractions.
  • Gibson Incision: For ureterolithotomy.

Additional Notes

  • Understanding the types and uses of surgical incisions is crucial for effective surgical practice and preparation.
  • Preparation includes knowledge of incision types and their specific applications based on surgical procedures.