In surgical practice, deciding on the right type of surgical access for a specific condition would be a skill of its own for a surgeon. The decision to select a specific incision would depend on the several ascpects e.g. surgical site, related anatomical structures, easy access, less complications, quicker healing and minimum scar. But, at instances, all these options might not be fulfilled and the surgeons have to make a professional judgment as to decide on what's best for the patients' condition and act fast in order to save the life of the patient.
Some of the more famous surgical incisions are:
An incision used to release pus in the lacrimal sac in acute phlegmonous dacryocystitis. It is named after Cornelius Rea Agnew
Cherney described a transverse incision that allows excellent surgical exposure to the space of Retzius and the pelvic sidewall. The skin and fascia are cut in a manner similar to a Maylard incision. The rectus muscles are separated to the pubis symphysis and separated from the pyramidalis muscles. A plane is developed between the fibrous tendons of the rectus muscle and the underlying transversalis fascia. Using electrocautery, the rectus tendons are cut from the pubic bone. The rectus muscles are retracted and the peritoneum opened.
This incision a cut is made on the abdomen below the rib cage. The cut starts under the armpit below the ribs on the right side of the abdomen and continues all the way across the abdomen to the opposite arm pit thereby the whole width of the abdomen is cut to provide access to the liver. The average length of the incision is approximately 24 to 30 inches.
An oblique incision made in the right lower quadrant of the abdomen, classically used for appendectomy Incision is placed perpendicular to the spinoumblical line at Mc Burney's point, i.e. at the junction of lateral one-third and medial two-third of spino-umblical line.
Hartmann incision is the incision of Hartmann's penis.
An oblique incision made in the right upper quadrant of the abdomen, classially used for open cholecystectomy. Named after Emil Theodor Kocher. It is appropriate for certain operations on the liver, gallbladder and biliary tract.[1][2] This shares a name with the Kocher incision used for thyroid surgery: a transverse, slightly curved incision about 2 cm above the sternoclavicular joints;
centering at McBurney's point, cosmetically better, used for open appendicectomy.
A variation of Pfannenstiel incision is the Maylard incision in which the rectus abdominis muscles are sectioned transversally to permit wider access to the pelvis.[3]
This is the incision used for open appendectomy, it begins 2 to 5 centimeters above the anterior superior iliac spine and continues to a point one-third of the way to the umbilicus (McBurney's point). Thus, the incision is parallel to the external oblique muscle of the abdomen which allows the muscle to be split in the direction of its fibers, decreasing healing times and scar tissue formation. This incision heals rapidly and generally has good cosmetic results, especially if a subcuticular suture is used to close the skin.[4]
This is the primary incision used for cardiac procedures. It extends from the sternal notch to the xiphoid process. The sternum is divided, and a finochietto retractor used to keep the incision open.[5]
The most common incision for laparotomy is the midline incision, a vertical incision which follows the linea alba.
Midline incisions are particularly favoured in diagnostic laparotomy, as they allow wide access to most of the abdominal cavity.
The Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis.[6][7] In the classic Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba is opened vertically. It is the incision of choice for Cesarean section and for abdominal hysterectomy for benign disease.
The Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for appendectomy.