Abdominal Incisions

Question 1

Applications of inguinal

Answer 1

left or right canal

inguinal or femoral herniorrhaphy

Question 2

Pfannensteil application

Answer 2

C-section

Question 3

Muscles of anterolateral wall

Answer 3

rectus abdominus

transverse abdominus

external oblique

internal oblique

Question 4

RLQ

Answer 4

appendix

Question 5

Hypogastric region

Answer 5

reproductive organs

Question 6

Thoracoabdominal pros and cons

Answer 6

exposure to upper abdomen and pleural cavity

most painful

Question 7

Subcostal applications

Answer 7

right-Kocher gallbladder/biliary system

left-spleen, adrenal gland

Question 8

McBurney

Answer 8

8cm oblique in RLQ

muscle-splitting

appendix (males)

Question 9

Vertical midline pros and cons

Answer 9

excellent exposure to abdominopelvic region and retroperitoneum

high post-op dehiscence, evisceration, herniation

poor cosmetic results

Question 10

Applications of vertical midline

Answer 10

full-AAA, kidneys, exploration (trauma)

Question 11

Pfannensteil

Answer 11

bikini

curved transverse

1cm above symphysis pubis

pelvic surgery/GYN

muscle-splitting rectus abdominus

Question 12

Thoracoabdominal applications

Answer 12

left-distal esophagus, stomach

right-liver

Question 13

Considerations for incision choice

Answer 13

exposure of area

minimize trauma, hemorrhage, post-op pain

maximize wound strength

length and time of closure

ease and rapidity of access

cosmetics

Question 14

Subcostal

Answer 14

oblique 2-5cm below margin

laterally and inferiorly from epigastric to lumbar region

Question 15

Subcostal pros

Answer 15

less painful than upper midline

excellent cosmetic results

Question 16

Inguinal

Answer 16

lower oblique/groin

2-5cm superior and parallel to inguinal crease

muscle-splitting of external oblique

Question 17

Pfannensteil pros and cons

Answer 17

excellent exposure

strong closure

excellent cosmetic results

rapid access, easy closure

nerve damage/hemorrhage if extended laterally

Question 18

Thoracoabdominal

Answer 18

curved following ribs

muscle-cutting of rectus abdominus
external oblique
serratus anterior
intercostals

Question 19

Vertical midline

Answer 19

median

simple, versatile

lease hemorrhagic due to entry through avascular linea alba

closed with retention suture

Question 20

Paramedian

Answer 20

vertical

4cm lateral to median on side

upper or lower

rarely used

muscle-splitting of rectus abdominus

Question 21

Upper anterior abdominal wall deep to superficial

Answer 21

peritoneum

preperitoneal (subperitoneal) fat

transverse abdominis aponeurosis

posterior rectus sheath (fascia)

rectus abdominus muscle

anterior rectus sheath (fascia)

external oblique aponeruosis

subQ fat

skin