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06-08-2008, 08:32 AM
mRequirements:
1- Accessibility: Gives adequate access.
2- Extensibility: Possible to be enlarged.
3- Safety: Not injure muscle or its nerve supply.
mTypes:
A) Vertical incisions.
1- Midline incision: Median epigastric & Median suprapubic.
Ä Advantages:
* Good access to both sides of the abdomen.
* Quickly made and enlarged freely.
Ä Disadvantages: Healing is poor and burst abdomen and incisional hernia liable to occur.
2- The paramedian incision:
Upper paramedian Rt. & Lt.
Lower paramedian Rt. & Lt.
Ä Advantages:
* Safe incision with no muscle cutting. {The rectus muscle is displaced laterally}.
* Have strong scar due to "trap-door" effect of if.
Ä Disadvantages: Takes much time to do and to close.
3- Trans rectal incision:
As paramedian but the scar is weaker as the medial part of the muscle will be denervated it is useful in children only.
4- Pararectal (Battle's incision):
It is similar to lower Rt. paramedian but more laterally placed so as to deviate the rectus. It is not used now as it can't be extended and medial deviation of the rectus muscle may injure its nerve supply.
B) Transverse incision.
1- Transverse epigastric incision:
Done mid way between umbilicus and xiphoid by muscle cutting.
Ä Advantages:
A) Gives good exposure to the upper abdomen.
B) Healing is supported by muscle contraction which pull transversely.
C) Nerve supply of recti is segmental so not affected.
Ä Disadvantages: Time consuming and gives more bleeding from epigastric vessels and muscular vessels.
2- Transverse supropubic (Pfanestiel)
Ä Incision:
* Widely used by gynecologists.
* The skin and ant. rectus sheath are incised transverse in the suprapubic crease then the recti are widely separated by retraction.
Ä Advantages: It gives good exposure to pelvic structures and more cosmetic.
Ä Disadvantages: Near to contaminated area.

3- Lanz's incision:
Modification of Mc Burney's in which the skin is incised transversely in the interspinous crease. It gives thin more cosmotic scar.

C) Oblique incisions.
1- Kocher's subcostal incision:
It is popular for cholecystectomy, splenectomy and partosystemic shunts.
It is done parallel to and one inch blew the costal margin extending from midline to the tip of ninth costal cartilage.
Ä Advantages: Hernias is less liable to occur.
Ä Disadvantages: Can't be extended & if hernia occurred it is difficult to treat.
2- Mc Burney's incision: See appendectomy.
3- Abbernethy's incision (Oblique iliac incision). treatment of stone ureter.

m Complications of Abdominal Incision:
1- Haematoma.
2- Infection: Stitch sinuses, Deep abscesses, Cellulitis or Meleney's ulcer.
3- Burst Abdomen.
4- Incisional hernia.
SOURCE: DR. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (www.vsegypt.org (http://www.vsegypt.org/)) &Medical Educational web (www.meduweb.com (http://www.meduweb.com/))
Not to be reproduced without permission of Vascular Society of Egypt

feempattviree
07-13-2011, 01:11 PM
Yes, CT scanning can detect abdominal fluid as well as fat. Mistakes can always happen but delineating fat from fluid is usually not very difficult on a CT scan.

If that helpful?

Mark