SURGICAL

INCISIONS
 SURGICAL INCISIONS
Importance of knowing the operative incision:
For the circulating Nurse:
a. Know the extent and the area to be
prepared.
b. To prepare the gadgets necessary for
positioning the patient.
 SURGICAL INCISIONS
Importance of knowing the operative incision:
For the scrub nurse:
a. To serve as guide for draping the
operative site.
b. To have the correct instruments and
supplies available.
c. To be able to assist the surgeon
effectively and efficiently.
 Layers of the abdomen
1. Skin
2. Subcutaneous Tissue
3. Fascia
4. Muscle
5. Peritoneum
Layers of the abdomen
 ABDOMINAL INCISIONS
1. Paramedian
2. Longitudinal midline
3. Upper midline
4. Lower midline
5. Subcostal/ Upper quadrant Oblique
6. Chevron
7. Mcburney’s
 ABDOMINAL INCISIONS
8. Mid-abdominal
9. Pfannenstiel
10.Inguinal Lower oblique
11.Sternal
12.Upper transverse
 ABDOMINAL INCISIONS
1. Paramedian

Øvertical incision about 4 cm., lateral

to the midline either side in the upper
and lower abdomen.
ØAllows quick entry into the abdominal
cavity
2. Longitudinal Midline incision
• It begins In the epigastrium at the level of the
xiphoid process and may extend vertically to
the suprapubic region.
• It can be upper abdominal, lower abdominal
or combination of both going around the
umbilicus.
F. Upper longitudinal midline
– incision started in the epigastrium at the level
of the xiphoid process & is carried
vertically downward to the level of the
umbilicus;
• Uses: Rapid entry into the abdomen to control
a bleeding ulcer, Gastric surgery, Exploratory
Laparotomy, Pancreatic surgery, Transverse
Colostomy.
G. Lower longitudinal Midline
– incision started opposite the umbilicus & is
extended vertically downward in the midline
of the suprapubic region..
Uses: Pelvic laparotomy, TAH-BSO, Cystectomy,
Cesarian section, Sigmoid colon operation.
3. Subcostal (Koecher’s) Incision
• A right or left oblique subcostal incision begins
at the epigastrium and extends laterally or
obliquely just below the lower costal region.
 4. Chevron incision
• A bilateral modified subcostal incision made
for increased visibility for liver transplantation
or resection.
 5. Mcburney’s Incision
• This is an oblique incision over mcburney’s
point.
• Mcburney’s point – Junction between the
outer third and the middle third of a line
drawn between the right superior iliac spine
and the umbilicus.
• Primarily Used for Appendectomy.
Mcburney’s Incision
6. Mid-abdominal Transverse Incision

• Is a mid abdominal transverse incision, which

extends out into the flank.
• Starts on either left or right side slightly above
or below the umbilicus. It may be carried
laterally to the lumbar region between the ribs
and crest of the ileum.
• Uses: Choledochojejunostomy*, Transverse
colostomy.
Mid-abdominal Transverse Incision
 7. Pfannenstiel’s incision
(Bikini Incision)
• Is a curved transverse incision across the lower
abdomen within the hairline of the pubis.
• Primarily used in Abdominal Hysterectomy.
8. Inguinal Incision (Gridiron Incision)

• An oblique incision in the inguinal region.

• Primarily used for Inguinal operations.
 9. Sternal Incisions

• Used in cardiac operations.

10. Thoracotomy Incision
a. Anterolateral - Incision is made from the
anterior midline or the external border to the
lateral mid-axillary line.
– Uses: Lung operation, Heart operation
b. Posterolateral – Incision is started posteriorly
below the scapula and extended oblique
direction anteriorly over or between two ribs.
-Uses: Lung operation
 Thoracotomy Incision
• Anterolateral Posterolateral
 Other incisions:
• Collar (curvilinear)
- Thyroidectomy
 Other incisions:
• Coronal (butterfly) - craniotomy
 Other incisions:
• Elliptical (halsted) – Radical mastectomy
 Other incisions:
• Limbal – Cataract extractions
 Other incisions:
• Gibson - ureterolithotomy
Surgical Positions
 SUPINE POSITION
• This is the usual position for administering
general anesthesia and for doing most surgery
of the abdomen such as laparotomy,
herniorrhaphy, and appendectomy.
TRENDELENBURG POSITION
• is used for operations on the bladder, prostate
gland, colon, female reproductive system, or
for any operation in which it is desirable to tilt
the abdominal viscera away from the pelvic
area for better exposure.
 LATERAL CHEST POSITION
• is used for thoracoplasty, pneumonectomy,
and lobectomy.
 LATERAL KIDNEY POSITION
• is used for surgery on the kidney or the
proximal third of the ureter.
 LITHOTOMY POSITION
• is used for surgery in the perineal area, such
as drainage of rectal abscesses and perineal
prostatectomies, and for gynecological surgery
such as vaginal hysterectomy.
 PRONE POSITION
• is used for surgical procedures that are
performed on the back, shoulders, neck, or
back of the head.
JACKKNIFE (KRASKE) POSITION
• is used for surgery on the coccyx, buttocks, or
rectum, hemorrhoidectomy particularly when
the patient has had spinal anesthesia and
there is no objection to his being placed either
face downward or head low.
JACKKNIFE (KRASKE) POSITION
 REVERSE TRENDELENBURG POSITION
• may be used for surgery on the neck, such as
thyroidectomy, and for certain abdominal
surgery, such as liver or gallbladder operations.
REVERSE TRENDELENBURG POSITION
 SITTING POSITION
• Included in surgery for which the patient sits
upright are various operations on the nose
and throat, as well as some plastic surgical
procedures. The sitting position
is described using the operating table as a
chair.
SITTING POSITION
POSITIONS FOR SPINAL ANESTHESIA

• This is the Sims position and is often referred

to as the curled lateral position and is useful in
establishment of subarachnoid and epidural
anesthesia.
POSITIONS FOR SPINAL ANESTHESIA

• Sitting Position
Surgical Skin
Preparation
 Surgical Skin preparation
The removal of as
many bacteria as
possible from the
patient’s skin
through shaving,
mechanical, washing,
and chemical
disinfection.
 Purpose:
• To reduce the risk
of post-operative
wound infection.
This is done by:
• Removing soil
and transient
microbes from the
skin.
Nursing Consideration in shaving

1. Determine the area to

be shaved and its extent;
know the operation to be
done; the organ involved
and its location and the
proposed incision.
 Nursing Consideration

2. Practice modesty
and provide privacy
 Nursing Consideration
3. Ask the patient’s
permission in cutting
the eyelashes and
hair.
 Nursing Consideration
4. Examine the
area to be shaved
for any signs of
irritation or any
abnormal
condition. Report
this to your head
nurse
 Nursing Consideration
5. Do not cut the
patient’s skin.
6. In abdominal
operations, pay
particular attention
to the umbilicus.
 Nursing Consideration
7. Shave the operative site the day
or the night before the operation
8. Discard soiled sponges in your
kidney basin.
 Nursing Consideration
• In shaving, follow the
direction of the growth
of the hair while the free
hand exerts an opposite
force by pulling the skin
to the opposite direction.
 Nursing Consideration
10. If a wound is present on the area to be shaved,
start from the clean area to the dirty area

11. Advise patients to shower or have a bath

(or help patients to shower, bath or bed bath)
using soap, either the day before, or on the
day of, surgery
 Skin prep on Operating Table
1. Area :
After patient has been anesthetized and
positioned on operating room table, skin of the
operative site and an extensive area surrounding
it is mechanically cleansed with an antiseptic
agent immediately prior to draping.
• Scrub the skin starting at the site of incision
with a circular motion in ever widening circles
to the periphery. Use enough pressure and
friction to remove dirt and microorganisms
from the skin and pores.
 Skin prep on Operating Table
• 2. Set-up: A sterile prep tray is opened on a small
table
Skin prep on Operating Table
3. Antiseptic solutions:
a. Chlorhexidine gluconate
b. Iodine and Iodophors
c. Alcohol
d. Hexachlorophene
e. Triclosan
 Skin preparations:
1. Abdominal Preparation
• Area includes breast
line to upper third of
thighs, from the table
line with the patient in
supine position.
 Skin preparations
2. Rectoperineal and Vaginal Preparation
• Area includes pubis,
vulva, labia, anus and
adjacent area, including
inner aspects of upper
thigh
 Skin preparation
3. Lateral Thoracoabdominal Preparation

• Area includes axilla, chest, and abdomen from

the neck to crest of ilium. Area extends from
midline, anteriorly and posteriorly. Patient is in
lateral position on operating table.
 Skin preparation
4. Chest and Breast Preparation

• Area includes shoulder, upper arm down to

elbow, axilla, and chest wall to table line and
beyond the sternum to opposite shoulder. If
patient is in lateral position, back is prepped also.
 Skin preparation
5. Hip Preparation

• Area includes abdomen on affected side, thigh to

knee, buttock to table line, groin and pubis.
 Skin preparation
6. Knee and Lower Leg Preparation

• Area includes entire circumference of affected

leg and extends from foot to upper part of thigh.