Abdominal wall incisions.pptx
- 1. Abdominal wall incisions Dr. Indunil Piyadigama Consultant Obstetrician and Gynaecologist Medical Director Base Hospital Kahawatta
- 2. Types of incisions Transverse Midline Laparoscopic
- 3. Transverse incisions Pfannenstiel Joel-Cohen incision and Misgav Ladach technique of operating Maylard transverse lower abdominal incision
- 4. Pfannenstiel 2 fingerbreadths (2-3cm) above the symphysis pubis Slightly curved along the Langers lines
- 5. Joel-Cohen incision 3 cm below the line joining anterior superior iliac spines. (above Pf) Straight
- 6. Langer lines
- 7. Maylard transverse lower abdominal incision Extends between the anterior superior iliac spines Cutting the rectus muscle and inferior epigastric artery Wertheims and pelvic node dissection can be done Less chance of hernia and wound dehiscence than midline
- 8. Midline incision From the skin fold below umbilicus to 1cm above symphysis pubis Close with delayed absorbable (PDS) mass closure
- 9. Advantages and disadvantages of horizontal incisions Advantages Disadvantages Easy to perform Limited access to the upper abdomen Quick to heal More blood loss Less post of pain Nerve entrapment 7% Better cosmetic outcome 30 times stronger than midline scar
- 13. Blood vessels
- 16. Thank you