TYPE OF INCISIONS ABDOMINAL INCISIONS: Vertical incision : Midline incision Paramedian incision Transverse and oblique incisions : Kocher's

9;s subcostal Incision

INDICATION/OPERATIONS General access, exploratory laparotomy

Exposure of the upper part of the abdominal cavity, intraumbilical, lower abdomen and pelvis Biliary or hepatic procedures. May be extended across to a left subcostal incision to give useful access to the stomach and pancreas. In newborns and infants, this incision is preferred,because more abdominal exposure is gained per length of the incision than with vertical exposure because the infants abdomen has a longer transverse than vertical girth. This is also true of short, obese adults, in whom transverse incision often affords a better exposure Appendicectomy,cecostomy Access to sigmoid colon and pelvis, particularly if the midline is very scarred from previous surgery. Access to bladder, uterus, Fallopian tubes and ovaries. Good cosmetic result but gives no access outside the pelvis. To expose the lower end of esophagus. Ex:esophagogastric resection for carcinoma Wide exposure to of the upper abdomen and thorax used to expose the anterior cranial vault, the forehead, and the upper and middle regions of the facial skeleton.

Transverse Muscle dividing incision

Mc Burneys Grid iron or muscle spliting incision Oblique Muscle cutting incision Pfannenstiel incision Abdominothoracic incision

HEAD INCISIONS Bicoronal incision

INCISIONS OF THE EXTREMETIES: Smith Peterson approach. - Schaubel Modification

Provides exposure to hip joint,ileum Indications

open reduction of congenital hip dislocations, synovial biopsies, intra-articular fusions, excision of pelvis tumors, pelvic osteotomies

. Posterior Approach to the Acetabulum (KocherLangenbach)

Provides exposure to o posterior wall of acetabulum o posterior column of acetabulum Indications

posterior wall, posterior column , posterior wall and posterior column, simple transverse (patient prone)

 Watson Jones approach

Provides exposure to acetabulum, proximal femur

Indications Hemiarthroplasty, ORIF of femoral neck fxs, synovial biopsy of hip, biopsy of femoral neck

INCISION OF THE SPINE: Anterior Approach to Cervical Spine

Exposes anterior vertebral bodies from C3 to T1 Indications excision of herniated discs, interbody fusion, removal of osteophytes from uncinate processes, excise tumors, debride osteomyelitis and drain abscesses

Retroperitoneal (Anterolateral) Approach to the Lumbar Spine

Can access L1 to sacrum o slightly more difficult to reach L5-S1 disk space than transperitoneal approach o bifurcation of great vessels occur at L4-5 Indications Psoas abscess drainage (without risk of postoperative ileitits), Spinal fusion, Biopsy or resection of vertebral body, Disc

replacement, Exposure of sympathetic chain (general surgery)

ABDOMINAL INCISIONS

http://www.orthonurse.org/portals/0/wound%20closure%20manual.pdf