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Abdominal Wall

Pfannenstiel Incision

Maylard Incision


Incisional Hernia

Abdominal Wound
Dehiscence and

Massive Closure
of the Abdominal
Wall With a One-Knot
Loop Suture

Hemorrhage Control Following Laceration
of Inferior Upper
Epigastric Vessels

Maylard Incision

The Maylard incision is an abdominal incision that can afford extensive exposure to the pelvic organs when this is needed. Although it can be used for most gynecologic procedures, it is not particularly useful in such upper abdominal surgeries as ovarian cancer that may be associated with tumor in and around the liver or spleen.

Its main disadvantage is that it is a more painful incision for the patient during the first postoperative week. This may be weighed against its reduced rate of incisional hernia and the fact that it is cosmetically advantageous, since it does not scar the midabdomen.

Physiologic Changes. None.

Points of Caution. Care must be taken to ensure the integrity of the ligature on the inferior epigastric artery lateral to the rectus fascia. We prefer a sloping U-shaped incision from the anterior superior iliac spine down slightly superior to the mons pubis to the superior iliac spine on the opposite side. This course should definitely be marked on the patient with brilliant green solution prior to making the incision.


With patient in the dorsal supine position, the proposed incision is marked on the abdomen with brilliant green solution.

The incision is made down to the rectus fascia.

The rectus fascia and rectus muscles are transected by using the electrosurgery technique. Care must be exercised at the lateral margin of the rectus muscle to ensure the integrity of the inferior epigastric artery and vein. The muscle is totally transected.

A small area of the peritoneal cavity is opened. A finger is placed in this opening, and the remaining portion of the peritoneum is opened with electrocautery.

Closure of a Maylard incision does not require suturing the rectal muscle stumps together. We have been impressed with the simple running suture for closing this incision. The skin and subcutaneous tissue can be closed with the automatic stapler or a subcuticular suture.

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