Incision and Wound

Closure in Gynaecology
Surgery

Key points

BRIEF Anatomy
Surgical Routes
General Consideration
Types of incision
Transverse VS Vertical

BRIEF Anatomy

Abdominal Wall

BRIEF Anatomy (Continued)

Orhan E. Arshlan, 2005

Abdominal Layer

Basic Principles
Approach :
- Abdominal : - Laparoscopy
- Laparotomy
- Vaginal

Basic Principles
Three Essentials :
1. Accessibility
2. Extensibility
3. Security

Zinner et al, 1997

Basic Principles
In the planning of an abdominal incision :
a. Preoperative diagnosis
b. The speed with which the operation needs to be
performed, as in trauma or major haemorrhage
c. The habitus of the patient
d. Previous abdominal operation
e. Potential placement of stomas

Nyhus & Baker (1992)

Type of incision

Transverse vs Vertical
Advantages
Transverse
- Best cosmetic
result
- Less painful
- Less
interference
with
postoperative
respirations
- Greater
strength

Disadvantages

Vertical

Transverse

Vertical

- Excellent
exposure
- Easily
extendable
- Median
incision is
least
haemorrhagic
- Minimum
nerve damage
- Rapid entry
into abdomen
and pelvis
with median
incision

- More timeconsuming
- More
haemorrhagic
- Compromised
ability to
explore upper
abdominal
cavity
- Division of
multiple layers
of fascia and
muscle and
nerves, may
result in
potential
spaces with
haematoma or
serotoma

- wound
dehiscence
and hernia
may be more
frequent
- Poorer
cosmetic
results
- Higher
infection rates,
haemorrhage
and operative
time with
paramedian
incision.