Common Abdominal Incisions

Midabdominal Transverse Incision starts on either the right or left side and slightly above or below the umbilicus. It may be carried laterally to the lumbar region between the ribs and crest of the ilium. The intercostal nerves are protected by cutting the posterior rectus sheath and peritoneum in the direction of the divided muscle fibers. The advantages are rapid incision, easy extension, a provision for retroperitoneal approach, and a secure postoperative wound. Examples of use: choledochojejunostomy and transverse colostomy. Pfannenstiel Incision a curved transverse incision across the lower abdomen and within the hairline of the pubis. The rectus fascia is severed transversely and the muscles are separated. The peritoneum is incised vertically in the midline. This lower transverse incision provides good exposure and strong closure for pelvic procedures. Examples of use: abdominal hysterectomy (TAH & TAHBSO) Subcostal Upper Quadrant Oblique Incision a right or left oblique incision begins in the epigastrium and extends laterally and obliquely just below the lower costal margin. It continues through the rectus muscle, which is either retracted r transversely divided. Although this type of incision affords limited exposure except for upper abdominal viscera, it provides good cosmetic results because it follows skin lines and produces limited nerve damage. Although painful, it is a strong incision postoperatively. Examples of use: splenectomy Inguinal Incision (Lower Oblique) extends form the pubic tubercle to the anterior crest of the ilium, slightly above and parallel to the inguinal crease. Incision of the external oblique fascia provides access to the cremaster muscle, inguinal canal, and cord structures. Examples of use: inguinal herniorrhaphy Longitudinal Midline Incision can be upper abdominal, lower abdominal, or a combination of both going around the umbilicus. Depending on the length of the incision, it begins in the epigastrium at the level of the xiphoid process and may extend vertically to the suprapubic region. After incision of the peritoneum, the falciform ligament of the liver is divided. An upper midline incision offers excellent exposure of and rapid entry into the upper abdominal contents. McBurneys Incision McBurneys point is located in the right lower quadrant, just below the umbilicus and 4cm (2in) medial from the anterior superior iliac spine. A McBurney incision involves a muscle-splitting incision that extends through the fibers of the external oblique muscle. The incision is deepened, the internal oblique and transversalis muscles are split and retracted, and the peritoneum is entered. This is a fast, easy incision, but exposure is limited. Examples of use: appendectomy

Paramedian Incision a vertical incision made approximately 4cm (2in) lateral to the midline on either side in the upper or lower abdomen. After the skin and subcutaneous tissue are incised, the rectus sheath is split vertically and the muscle is retracted laterally. This incision allows quick entry into and excellent exposure of the abdominal cavity. It limits trauma, avoids nerve injury, is easily extended, and gives a firm closure. Examples of use: sigmoid colon resection Thoracoabdominal Incision the patient is placed in a lateral position. Either a right or a left incision begins at a point midway between the xiphoid process and umbilicus and extends across the abdomen to the seventh or eighth costal interspace and along the interspace into the thorax. The rectus, oblique, serratus, and intercostal muscles are divided.

OPERATING ROOM SAMPLE CHARTING DATE TIME OF ENTRY > In to OR a 33 year old, male, per stretcher accompanied by transport aide and staff nurse with consent signed for TP Emergency Appendectomy Pre-operative S > I am nervous but I prepared myself for this. O > With the first IVF of D5LRS 1L at 600 cc level infusing well over right arm at a rate of 30 drops per minute. With an indwelling foley catheter attached to hospicare draining to light yellow urine amounting to 50 cc. 6:35 > Wheeled to OR and transferred to OR bed. Attached to pulse oximeter by ____ Hooked to cardiac monitor by ______ 6:40 > General anesthesia inducted by Dr. ______ assisted by _______ Intubation done using size 7.5 ETT with ease Abdominal skin prep done by Dr.____ Aseptically draped by ________ Initial sponge count done by ________ A > Patient is physically prepared for the operation P > Checked consent and maintenance for NPO Placed client comfortably and safely on OR bed by applying strap Participated in initial sponge count Observe aseptic technique as needed Intra-op 6:50 > Operation started whereby an incision at MCBurneys point was done By ______ assisted by Dr. Tan Deeper incisions done Bleeders clamped and cauterized Suctioning done Exploration, identification, and isolation of the inflamed appendix done 7:05 > Specimen out characterized as elongated, approximately 3-5 cms in length, 1 cm in diameter, congested and reddish in color Abdominal washings with NSS followed by intermittent suctioning done Suturing of the appendicial stump Checked for bleeders Final sponge count done and certified correct by_______ Layer by layer suturing done 7:35 > Operation ended whereby appendectomy was done A > Patient underwent operation with minimal blood loss P > Anticipated needs of the surgical team Maintained aseptic technique throughout the procedure Participated in the final sponge count Post-op O >Betadine and dressing applied on wound 7:45 >Extubation done by _______; oral airway applied by

________ Oropharyngeal suctioning done Patient still asleep from anesthesia Urine output 200 cc 7:55 > Transferred to RR bed A > Patient tolerated procedure well P > Assisted with extubation Provided safety by staying beside the patient 8:00 > To RR per RR bed accompanied by nursing aide with an IVF of D5LRS 1L 2nd bottle at full level regulated at 40 drops per minute. Signature over printed name POST ANESTHESIA CARE UNIT CHARTING 8:03 > In to RR a 33 year old, male accompanied by OR technician, student nurse ____ and Dr. _____ TP: Immediate status post appendectomy O > Patient is asleep but arousable V/S T 36.7 C PR 72/min strong and regular RR 20/min regular and spontaneous BP 110/70 O2 inhalation administered by R.N. Labon at 2L/min by nasal cannula With an IFC connected to hospicare bag, with an output of 30 cc, clear yellowish urine Abdominal dressing dry and intact Skin warm to touch With good capillary refill of 1-2 seconds 8:20 > Patient awake and nauseated, DBE instructed, emesis basin placed on standby Complained of pain with a rate of 10 over incision site, Nubain 10 mgs IV given by _____________ Skin test for cefalexin done over right arm due at 9:00 Am 8:30 > Patient still nauseated, Plasil 10 mgs IV given by __________ 9:00 > Skin test of cefalexin revealed a negative result as read by ___________, first dose of cefalexin 500 mgs IV given by ________. 9:30 > Patient with stable condition, given orders for discharge from PACU A > Patient is still recovering from effects of anesthesia P > Monitored V/S Provided safety by staying with the patient, raising bed side rails NPO instructed DBE encouraged and demonstrated 9:32 > To ward per stretcher accompanied by transport aide and _____ with an IVF of D5LRS 1L at 600 cc level regulated at 30 drops per minute. Signature over printed name