Introduction
A planned surgical incision is important in surgery. The location of the incision should provide optimal visualization. The size and location of the incision are important factors in aesthetics. Therefore, the anatomy and blood supply should always be considered while the incision is made.
What Is a Surgical Incision?
An incision is a cut made through the skin for surgical purposes to treat the underlying tissue, organ, or bone. It is also called a surgical wound. Incisions are made with sharp instruments called scalpel that helps incise clean edges and heal wounds well, or an electrocautery tool that helps to incise and stop bleeding. The size and location of the incisions depend on the type of surgical procedure.
What Are The Types Of Incisions?
The different types of incisions made in the abdomen and chest region are:
1. Midline Incision: It is also called laparotomy incision for abdominal surgery. It is a traditional incision, and its size depends on the type of procedure performed. It can be small (anywhere on the vertical linea alba) or large (extending from the xiphoid process to the pubic bone).
Advantages of this incision include:
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The location of this incision is avascular and does not cause risk to the blood supply.
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Nerve damage is rare.
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Multiple incisional operations can be performed on the same incisional scar.
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Provides the best visualization and intra abdominal access.
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It is commonly used for exploratory procedures to diagnose diseases and for trauma.
2. Kocher Incision (Subcostal Incision): This incision is given on the right side of the abdomen and is used to expose the gallbladder and biliary tree. The blood supply of the distal aspect of the superior epigastric, inferior epigastric external oblique perforators, and perforating intercostal arteries are interrupted by this incision. It has the disadvantage of a slight increase in postoperative pain.
3. Para-Median Incision: This incision is made 3 centimeters lateral to the midline. After exposing the subcutaneous tissue and rectus sheath (fascial coverings of the muscles of external oblique, internal oblique, and transversus abdominis), the peritoneum is exposed.
4. Gridiron Incision: This is an oblique incision made in the right lower quadrant of the abdomen, extending from two-thirds of the umbilicus to the bony projection of the iliac bone. This incision is used for appendectomy (removal of the appendix). Advantages of this incision include:
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Faster healing and less scar tissue formation because the incision is parallel to the external oblique muscles.
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Good cosmetic results.
5. Lanz (Rockey-Davis) Incision: This incision is similar to a gridiron incision, except it is horizontal. This is used in open appendectomy.
6. Thoracoabdominal (Ivor Lewis) Incision: This incision connects the pleural cavity to the peritoneal cavity and exposes lateral organs, the distal esophagus, pleural space, and retroperitoneal space. Right-sided incision exposes the hepatic region and right kidney. Left-sided incision exposes the stomach and distal esophagus.
7. Chevron Incision: This incision crosses the midline of the abdomen. It provides access to retroperitoneal space and the intra abdominal cavity. The hepatic, pancreatic, adrenal, upper gastrointestinal region, or renal surgeries are done using this incision.
8. Pfannenstiel (Kerr or Pubic Incision): It is a transverse incision made in the lower abdominal region and above the pubic ridge. A vertical incision enters the peritoneum. Urologic, orthopedic, pelvic, and cesarean section surgeries use this incision.
9. McEvedy Incision: It is a vertical incision extending from the femoral canal to the inguinal ligament. It allows access to the femoral canal and peritoneum. Femoral hernias surgery uses this incision.
10. Subclavicular Incision (Infraclavicular Incision): This incision is made inferiorly to the clavicle and provides access to the subclavian vessels.
11. Supraclavicular Incision: This incision is made superior to the clavicle. It extends from the clavicle to the sternum’s midline. This incision can meet cervical or sternotomy incisions and provide excellent exposure to thoracic and cervical anatomy.
12. Median Sternotomy Incision: It is a vertical incision made on the sternum and provides access to the pleural cavity, mediastinum, aorta, branches to the head and upper extremities, and epigastric region. Open heart surgeries are performed through this incision.
13. Trapdoor Incision: It combines collar, sternotomy, and lateral extended incision. This incision exposes pleural space, cervical vasculature, mediastinum, and heart. It is used to control bleeding from penetrating trauma.
14. Clamshell Incision: It is a large transverse incision made on the entire chest wall. This incision is used in lung transplants, massive chest trauma, or resection of tumors in the chest.
15. Mercedes-Benz Incision: It is a modification of Chevron Incision. It is used in liver transplant surgeries or organ removal in the epigastric region (the upper central abdomen).
16. Supra-umbilical or Infra-umbilical Incision: It provides access to the peritoneum. Due to the umbilical cord, the incision is made around it. Infra umbilical incision may be vertical or transverse in case of open umbilical hernia repair. Supra umbilical incisions are used for hernia repair when there is an infra umbilical incision.
17. Pararectus Incision: This incision is made laterally to the rectus abdominis muscle. It is used in Spigelian hernia and ostomy.
18. Maylard Incision (Mackenrodt) Incision: This incision is made transversely, 2.3 inches above the pubic tubercle. It provides access to the pelvic structures.
19. Gibson Incision: This incision is made parallel and above 1.1 inch to the inguinal ligament. It is used in gynecological and urological procedures.
20. Inguinal Incision (Groin): This is an oblique or transverse incision made above the inguinal canal. Open inguinal hernia repair surgery uses this incision.
The different types of incisions made in the neck region are:
1. Carotid Incision: It is a vertical incision along the sternocleidomastoid muscle's anterior aspect. Carotid endarterectomy (a surgical procedure to remove fatty deposits that narrow down carotid arteries), thyroidectomy (removal of the thyroid gland), and tracheostomy (an opening done in front of the neck to insert a tube that helps in breathing) surgeries use this incision.
2. Macfee Incision: It is a horizontal cervical incision. It is used to remove tumors located in the oropharynx or oral cavity. A modified macfee incision has better cosmetic results.
3. Modified Schobinger Incision: This incision is used for radical neck dissection.
4. Reverse Hockey Stick Incision: This incision is used for lymph node dissections.
Conclusion:
There are many different incisions to access different body organs. An improper incision may cause injury to blood vessels and other structures. For abdominal surgeries, a midline incision is commonly used. Before the surgery, the surgeon must explain the procedure, the type of incision, and its complications to the patients.
