-
- Midline sternotomy
- CABG (look for scar from vein
- harvesting on leg/arm/could be internal thoracic arteries)
- Valve
- Aortic dissection
- Transplant
- Congenital cardiac defect corrections
-
Axillary thoracotomy
- A bit higher than posterolateral thoracotomy
- Muscle sparing
- Pneumothorax
- Pulmonary resections (pneumo/lobectomy, wedge)
- Pleurectomy
-
- Posterolateral thoracotomy
- Pulmonary resections: Pneumonectomy, Lobectomy, wedge
- Oesophagus
- Heart/aorta
- Chest wall resection
-
- Anterolateral thoracotomy
- MVR/mitral valvotomy
- Coarctation repair
- Lobectomy
- Oesophagectomy if rooftop
- also present
- Left: open chest massage
-
- Subclavicular scar
- Pacemaker
-
- Lanz scar
- Appendicectomy
- More transverse, medial, closert to ASIS than McBurney's - can be hidden in a skin crease
-
- McBurney's scar
- Appendix
- At McBurney's point (2/3 to ASIS from umbilicus), perpendicular to this line
-
- 1. Kocher
- 2. Midline
- 3. McBurney
- 4. Battle incision (appendicectomies - rare)
- 5. Lanz
- 6. Paramedian
- 7. Transverse incision
- 8. Rutherford Morrison
- 9. Pfannenstiel
-
When to perform a transverse incision
- In children/neonates - lack of diaphragmatic and pelvic recesses (difficult in adults because of subdiaphragmatic and pelvic structure)
- Quick healing, fewer respiratory complications than midline, less pain
-
- Pfannenstiel
- C section (and other gynae)
- Lower GI/UT
- Hernias (esp. bilateral)
- Prostate
-
- Kocher's scar
- Cholecystectomy
- Liver/gall bladder/biliary tract
-
- Rutherford Morrison scar
- Kidney transplant
- Colonic resection / caecostomy (R) / sigmoid colostomy (L)
-
- 'Mercedez benz' - bilateral rooftop with sternal extension
- Diaphragmatic hernias
- Rooftop indications
-
Rooftop indications
- aka Chevron
- Gastrectomy
- Oesophagectomy
- Bilateral adrenalectomy
- Liver resections
- Liver transplant
- Kidneys
-
- Midline laparotomy
- Most abdominal operations
-
Paramedian indications
extension?
- Spleen
- Kidney
- Adrenal
- Mayo-Robson scar: paramedian incision, curved towards xiphoid process - allows bigger opening
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