TRANSVERSE INCISIONS

Advantages
 Best cosmetic results
 Less painful
 Less interference with postoperative respirations
 Greater strength - Earlier studies reported that increased
incidence of eviscerations with vertical incisions might be
associated with inappropriate closures. Recent studies have
shown no difference in fascial dehiscence between
transverse and vertical incisions.
Disadvantages
 More time‐consuming
 More haemorrhagic
 Compromised ability to explore upper abdominal cavity
 Division of multiple layers of fascia and muscle and nerves,
Cherney incision
may result in potential spaces with haematoma or seroma
The Cherney incision involves transection of the rectus muscles
at their insertion on the pubic symphysis and retraction cephalad
Pfannenstiel incision
to improve exposure. This can be used for urinary incontinence
Introduced by Pfannenstiel in 1900, this curved incision is
procedures to access the space of Retzius and to gain exposure
approximately 10–15 cm long and 2 cm above the pubic
to the pelvic side‐wall for hypogastric artery ligation.
symphysis. The skin and rectus sheath are opened transversely
using sharp dissection. The rectus muscles are not cut and the
fascia is dissected along the rectus muscles.

Küstner incision
The Küstner incision, sometimes incorrectly referred to as
modified Pfannenstiel incision, involves a slightly curved skin
incision beginning below the level of the anterior superior iliac
spine and extending just below the pubic hairline. The superficial
branches of the inferior epigastric artery or vein may be
encountered in the fat. This incision is more time‐consuming and
extensibility is limited.
Maylard incision
The Maylard incision is a muscle‐cutting incision, in which all
layers of the lower abdominal wall are incised transversely
approximately 3–8 cm above the symphysis, depending on the
patient habitus and indication for surgery. The fascia is not
dissected free of the rectus muscles. The peritoneum is usually
entered in a transverse fashion. In a patient with clinical evidence
of impaired circulation in the lower extremity, a midline incision
should be preferred to the Maylard incision, in view of the risk of
lower extremity ischaemia secondary to inferior epigastric artery
ligation.
 lateral border of the rectus, but remains medial to the internal
oblique and transversus abdominis muscle bellies. A Kocher
clamp can be placed on the aponeurosis for traction as it is
separated from the muscle by blunt and sharp dissection. The
pyramidalis muscles usually remain attached to the aponeurosis.
The rectus muscles are separated from the transversalis fascia
and the peritoneum is incised in the midline.
The Turner-Warwick incision provides excellent exposure to the
retropubic space, but upper pelvis and abdominal exposure is
severely limited.

Mouchel incision
The Mouchel incision runs at the upper limit of the pubic hair and
is thus lower than the Maylard incision. The muscles are divided
above the openings of the inguinal canals.

Joel‐Cohen incision
Professor Joel‐Cohen introduced this incision for abdominal
hysterectomy in 1954 and obstetricians have since used this
widely to perform caesarean sections.6 This is a straight
transverse incision through the skin, 3 cm below the level of the
anterior superior iliac spines (higher than the Pfannenstiel
incision). The subcutaneous tissues and fascia are opened in the
midline and extended laterally with blunt finger dissection. Blunt
dissection is used to separate the rectus muscles vertically and
then open the peritoneum.

References
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/tog.1206
3
https://somepomed.org/articulos/contents/mobipreview.htm?
2/36/2625#H21
Turner-Warwick's incision
Turner-Warwick's incision is centered 2 to 3 cm above the
symphysis and placed within the lateral borders of the rectus
muscles. The lower pole of the rectus muscles from below the
symphysis are separated from the overlying sheath. The
aponeurosis incision is usually 2 cm below the symphysis and 4
cm across. The rectus sheath incision is angled upward to the