Surgical incision

A surgical incision is a cut made through the skin and soft tissues of the body to expose an underlying tissue, bone or organ so that a surgical procedure can be performed. An incision is typically made with a sharp instrument such as scalpel that is extremely sharp and leaves the skin and tissues with clean cut edges that are able to heal well.

Incisions can also be made with an electrocautery tool which uses heat to both cut and cauterize at the same time, which can dramatically minimize bleeding during procedure.

Incision size

A traditional ‘open’ incision is a large incision used to perform surgery. An open incision is typically at least three inches long but may be much larger, varying from surgery to surgery and the severity of the problem. This allows surgeon enough room to work and see the area that is being worked on and to insert the necessary surgical instruments to perform surgery. An incision may also be enlarged during surgery in order to give the surgeon more room to work.

Surgical incision, in general, are getting much smaller these days. Laparoscopic or minimally invasive ‘keyhole’ incisions are much smaller than the traditional open incisions and are just large enough to allow surgical instruments to be inserted into the body. Instead of having one incision, that is four inches long, the person may have three or four that are less than an inch long. For abdominal surgeries one of these is often hidden in the belly button so scarring is minimized. It is easier for the body to heal multiple small incisions rather than a large incision.

Abdominal incisions

1. Midline incision/laparotomy: Incision that follows the linea alba (a relative avascular structure) to access most of the abdominal viscera. This type incision is performed for a variety of abdominal surgeries including emergency procedures as this incision causes minimal blood loss. The downside is the susceptibility of significant scars

• Paramedian incision: An incision 2-5 cm lateral to the midline is used to access mostly the lateral viscera (such as kidney. spleen and adrenal glands). The anterior rectus sheath is separated and moved laterally, preventing any division of the rectus muscle.

• Kocher incision:. The incision is subcostal incision on the right side of abdomen used for open exposure of the gallbladder and biliary tree. The incision is just inferior and parallel to the subcostal margin. Variations of Kocher’s incision are chevron/roof top incision to the other side of abdomen. This is used to access the esophagus, the stomach and the liver. Transverse incision These vary in size and location. When a full-length transverse incision is made, some muscles (oblique, transverse and rectus abdominis) and linea alba are cut causing more blood loss than the midline incision.
• Pfannenstiel-Kerr incision/pubic Incision: This is an infraumbilical transverse incision in the lower abdomen mostly used for gynecological and obstetric procedures. The skin is often incised transversely often with a convexity downward to avoid dissection of blood vessels and nerves.

• Lanz and Gridiron incisions: Used to access the appendix, and mostly to perform appendectomy. The incision is made at McBurney’s point. In comparison with Gridiron incision, Lanz incision produces better aesthetic result with reduced scarring as it follows the Langer’s lines.
• Rutherford incision: This is similar to Gridiron incision, but the surgeon extends the incision into an oblique and curvilinear orientation, facilitating access to the ascending colon and sigmoid. Also used for kidney transplantation.
• McBurney incision: This incision provides good exposure for performing open appendectomy and is made obliquely at McBurney’s point, two-thirds from the umbilicus to the anterior superior iliac spine.

• Battle incision: This is a lower right paramedian incision but placed more laterally than standard paramedian incision.  It is suitable for dealing with acute appendicitis and pathologies in the lower right quadrant of abdomen.

Care to prevent surgical site infection

A person’s skin is a natural barrier against infection. Even with many precautions and protocols to prevent infection are in place, any surgery that causes a break in the skin can lead to an infection. Chances of developing surgical site infections are about one to three per cent. It is therefore, very essential for health professionals involved in the preparation of patient for surgery, procedure of surgery and care after surgery to pay utmost attention for the safety of clients and to stay free of infection.

Postoperative Incision Care

• Keep the site clean and dry for the first 3 days.
• Avoid soaking or submerging the incision until cleared by the surgeon.
• Use Band-Aids to protect itchy sutures—discourage scratching.
• Watch for signs of infection: redness, swelling, warmth, discharge, or fever.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
8. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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