What is a transverse incision used for?

According to a study published in the journal Vertical compared with transverse incisions in abdominal surgery, transverse incisions are associated with fewer postoperative complications than vertical incisions. A transverse incision is a horizontal cut made across the abdomen or other body part for surgical purposes.

Quick Summary

A transverse incision is a horizontal surgical cut used across the abdomen or other body parts to access internal organs, commonly for procedures like C-sections, gynecologic surgery, and some abdominal operations. It is often favored for its cosmetic results, lower risk of hernia, and reduced postoperative pain compared to vertical incisions.

Key Points

• Cosmetic Advantage: Transverse incisions are often used because they result in a more cosmetically pleasing scar, as they follow the body's natural skin tension lines.

• Reduced Complications: They are associated with a lower incidence of incisional hernia and other complications like wound dehiscence compared to vertical incisions.

• Less Postoperative Pain: Patients often experience less pain after a transverse incision, particularly when coughing or breathing deeply.

• Common in Obstetrics: The low transverse incision, like the Pfannenstiel, is the standard for most Caesarean sections due to its low complication rate.

• Specific Surgical Access: Different transverse incision types, such as the Kocher for gallbladder surgery, are used to provide targeted access to specific organs.

• Not for all Procedures: While beneficial, a transverse incision offers more limited access to the abdominal cavity than a vertical incision and is not suitable for all types of surgery, especially emergency procedures requiring broad exposure.

What is a transverse incision used for?

A transverse incision, a horizontal cut made across the body, is a standard surgical technique utilized for a wide variety of medical procedures, especially in the abdominal and pelvic regions. Unlike a vertical midline incision that runs from the breastbone down to the navel, a transverse incision follows the natural contour of the body's skin folds. The specific location and technique of the transverse incision vary depending on the target area and the type of surgery being performed, making it a versatile and widely-used approach in modern medicine.

Applications of Transverse Incisions

The applications for a transverse incision are extensive and cover several medical specialties. Its use is determined by the surgeon based on factors like the required surgical exposure, cosmetic outcome, and potential for complications.

Gynecological and Obstetric Procedures

One of the most common applications for a transverse incision is in obstetrics and gynecology. The Pfannenstiel incision is a well-known transverse cut used for procedures involving the pelvic organs.

• Caesarean Sections (C-sections): The low transverse uterine incision is the standard approach for most C-sections due to its low bleeding, good healing, and reduced risk of uterine rupture in future pregnancies compared to vertical incisions.
• Hysterectomies: Transverse incisions are frequently used for abdominal hysterectomies, where the removal of the uterus is necessary.
• Pelvic Surgery: Many other pelvic procedures, including repair of pelvic organ prolapse or removal of fibroids, utilize a low transverse approach.

General Surgery

In general surgery, transverse incisions offer specific advantages for accessing organs and structures in certain areas of the abdomen.

• Colon Surgery: Some colectomies (removal of part of the colon) can be performed through transverse incisions, particularly for cancers in specific locations.
• Appendectomies: A transverse incision, such as the Davis-Rockey incision, can be used for open appendectomies, offering better cosmetic results.
• Gallbladder Removal (Cholecystectomy): A subcostal transverse incision, known as a Kocher incision, is used for open removal of the gallbladder.

Vascular Surgery

Vascular surgeons may opt for transverse abdominal incisions when repairing abdominal aortic aneurysms or performing aortofemoral bypasses. This approach can provide excellent access to specific sections of the aorta.

Types of Transverse Incisions

There are several types of transverse incisions, each tailored for specific surgical needs. Some of the most notable include:

• Pfannenstiel Incision: A low, curved horizontal incision just above the pubic hairline. The skin and subcutaneous fat are cut transversely, but the deeper tissues (rectus fascia) are often opened vertically. It is favored for its cosmetic outcome and low pain.
• Maylard Incision: Similar to the Pfannenstiel, but the rectus abdominis muscles are cut horizontally to provide wider access to the pelvic cavity. It is often used for more extensive gynecological or pelvic procedures.
• Cherney Incision: This variation involves detaching the rectus muscles from the pubic bone to improve access to the pelvic structures without cutting the muscles themselves.
• Kocher Incision: An oblique transverse incision made parallel to the right costal margin (rib cage), providing excellent access to the liver, gallbladder, and biliary tree.
• Chevron Incision: A bilateral subcostal incision, essentially a Kocher incision extended across the midline, forming an inverted V-shape. This offers broad exposure to the upper abdominal organs, including the pancreas.

Advantages and Disadvantages Compared to Vertical Incisions

Choosing between a transverse and a vertical midline incision is a key decision for surgeons, with each having distinct pros and cons.

Comparison of Transverse vs. Vertical Midline Incisions

Feature	Transverse Incision	Vertical Midline Incision
Cosmetic Result	Superior. The scar often aligns with Langer's lines (natural skin tension lines), resulting in a less noticeable scar.	Inferior. The scar runs perpendicular to skin tension lines, often leading to a more visible, wider scar.
Postoperative Pain	Less. Cutting through muscle tissue horizontally causes less tension, reducing pain, especially during coughing and deep breathing.	More. Causes more pain postoperatively due to tension on the incision.
Hernia Risk	Lower. The incision aligns with abdominal muscle fibers, leading to a stronger and more secure fascial repair.	Higher. The incision runs along the linea alba, a less vascular area, which can be prone to incisional hernias.
Surgical Access	Limited. Provides excellent access to the immediate area but offers poorer access to the entire upper and lower abdomen without extension.	Broad. Allows for excellent and rapid access to the entire abdominal cavity and can be easily extended.
Risk of Complications	Lower risk of burst abdomen and pulmonary complications.	Higher risk of some postoperative complications due to greater fascial disruption.
Speed of Entry	Generally takes longer to create than a midline incision.	Faster to enter the abdomen, making it suitable for emergency procedures.

Conclusion: A Strategic Choice in Surgery

The choice to use a transverse incision is a deliberate one, made with the patient's specific condition and desired outcomes in mind. While it may offer more limited access compared to its vertical counterpart, the benefits of less pain, a more favorable cosmetic outcome, and a lower risk of long-term complications like incisional hernias are significant. In procedures like C-sections or certain gallbladder operations, a transverse incision is the preferred technique, showcasing modern surgery's move towards less invasive and more anatomically sound approaches. As with all surgical decisions, patients should discuss the type of incision and its implications with their surgeon. For more information on surgical procedures and techniques, an excellent resource is available at Medscape.

Frequently Asked Questions

Is a transverse incision the same as a C-section cut?

Yes, for most C-sections, a surgeon will use a low transverse uterine incision. The skin incision, known as a Pfannenstiel, is also a type of transverse incision located just above the pubic hairline.

Is a transverse incision better than a vertical incision?

The choice depends on the surgery. Transverse incisions are generally associated with less pain, better cosmetic results, and a lower risk of hernia formation. However, vertical incisions offer faster and broader access for emergency or complex abdominal procedures.

What is the recovery like with a transverse incision?

Recovery with a transverse incision often involves less pain and discomfort compared to a vertical incision. This is because the incision cuts along, rather than across, the main abdominal muscles, leading to less stress on the wound.

Can a transverse incision be used for appendectomy?

Yes, a transverse incision (e.g., Davis-Rockey incision) can be used for open appendectomies. It provides good access to the appendix and offers a more cosmetic result than other approaches.

What is a Maylard incision?

A Maylard incision is a type of transverse incision where the rectus abdominis muscles are cut horizontally to provide wider access to the pelvic area. It is typically used for more complex gynecologic or pelvic procedures.

What is the risk of a hernia after a transverse incision?

The risk of an incisional hernia is significantly lower after a transverse incision compared to a vertical midline incision. This is due to the natural alignment of the incision with the abdominal muscle fibers, which creates a stronger wound closure.

Are there different types of transverse incisions?

Yes, there are several types of transverse incisions, each named after the surgeon who developed it or the area it accesses. Examples include the Pfannenstiel for pelvic surgery, the Kocher for gallbladder surgery, and the Maylard for wider pelvic access.