Purpose of incision

• Access
• Optimise healing
• Good cosmesis

Additional considerations:

• Neurovascular structures below incision line which may be injured
• Previous wounds which may impede blood supply to wound (parallel linear wounds render separated tissue inschaemic)
• Relaxed skin tension lines
• Avoid multiple cuts into fat (risk of fat necrosis)

Specific Incisions

• Transverse: (1) muscle cutting (2) muscle splitting
• Midline: "incision of indecision" rapid access, minimal blood loss, easy closure
• Kochers
• McBurney/gridiron
• Lanz
• Rooftop
• Paramedian: take longer to form, close, higher risk of blood loss, low complication rate
• Suprainguinal (Rutherford-Morrison)
• Inguinal
• Pfannenstiel

Principles of wound closure

• Edges should be in good apposition (with slight gaping to allow for swelling)
• Wound edges should be everted
• Minimal suture material should be used to secure wound
• Knots should be secure, to one side of wound and easy to remove

Closure options

1. Heal by primary intention
2. Heal by secondary intention +/- VAC, large surface area wounds, large cavitating wounds
3. Delayed primary closure
4. Steri-strips
5. Tissue glue
6. Skin staples
7. Sutures
   • Subcuticular - good cosmesis, suitable for clean linear wounds
   • Simple interrupted
   • Vertical mattress
   • Horizontal mattress