Understanding the Three Main Types of Surgical Incisions

Common Incision Types in Surgery: A Complete Guide

An incision is a cut or tear made in the body during a surgical procedure by any sharp tool, like a scalpel, to access internal structures for medical procedures. The size and location of the incision depend on the specific surgery.

The Three Main Types of Incisions

There are mainly three types of surgical incisions, which refer to the direction of the cut made through your skin and underlying tissues. Here we will highlight these three types in detail. These include:

1. Vertical Incisions
 

A vertical incision in surgery where surgeons cut the length of your body, typically along the midline abdomen (like the linea alba) or slightly off-centre (paramedian). It offers better access for certain procedures but can have drawbacks, such as an increased risk of hernias and longer healing times.

Here are some subtypes of vertical incisions in the surgical field:

• Midline incision: A straight cut along your linea alba, the fibrous structure in the middle of your abdomen. It is a common incision for laparotomies (abdominal surgeries). However, doctors sometimes use this in a C-section during delivery.
• Paramedian incision: A paramedian incision is made parallel to the midline, often retracting the rectus abdominis muscle medially or laterally to access underlying structures while potentially providing greater strength than a midline incision.

2. Transverse Incisions

A transverse incision is a surgical cut which doctors make horizontally across your abdomen, typically below your belly button. It is a common approach for various abdominal surgeries, offering wide access to organs and potentially leading to better healing and cosmetic outcomes.

These are the types of transverse incisions:

• Pfannenstiel incision: It is a type of surgical incision in your lower abdomen. Surgeons commonly use this procedure in gynaecological and obstetrical procedures, including caesarean sections.
• Maylard incision: Doctors commonly use this surgical incision procedure in gynaecological and other pelvic surgeries. It involves cutting through your rectus abdominis muscles after ligation of the inferior epigastric vessels, providing exposure of the pelvis.
• Chevron incision: A chevron incision is a surgical incision which doctors perform below the rib cage, extending from one mid-axillary line to the other across the abdomen. Surgeons often use this procedure for liver surgery and other upper abdominal procedures.
• Supraumbilical transverse incision: A supraumbilical transverse incision is a surgical incision made above the umbilicus and horizontally across the abdomen. Doctors apply these incisions in infants and young children to get optimal access to the entire abdominal cavity.
   

3. Oblique Incisions

An oblique incision is a type of surgical cut made at an angle, rather than straight across or vertically. Many surgeons commonly use this procedure in various operations, including hernia repair, appendectomy, and vascular surgery. This incision procedure is widely preferred due to its aesthetic and healing benefits.

These are some subtypes of oblique incisions:

• Gridiron (McBurney) incision: Surgeons performthis muscle-splitting incision obliquely in the right lower abdominal region, traditionally for appendectomies. Doctors place this at McBurney’s point (a specific location on the abdomen to access the appendix), proceeding through the external oblique and transversus abdominis.
• Lanz incision: The Lanz incision, or Rockey-Davis incision, is a surgical incision where doctors centre over McBurney’s point to operate. This surgical incision is a common procedure for open appendectomy.
   

Other incision types include thoracotomies for chest procedures, which can be posterolateral, anterolateral, or axillary. The choice of incision depends on the specific procedures, the organs involved, and the surgeon’s preference.