Chapter 6: Table of Contents
Linea Alba Incision
If you have difficulty identifying the linea alba, remember that it is widest at the level of the umbilicus. You might also be able to palpate a dimple or an irregularity at the level of the umbilicus which can guide you to find the linea alba.
Once you have identified the linea alba, grasp it with a pair of thumb forceps and tent it upward to create a distance between it and the internal organs. The right-handed surgeon typically stands on the patient’s right side and should stab as caudal as possible along the incision to facilitate handling of the instruments and tissues during extension of the incision (cutting from right to left). Using a scalpel blade with the cutting edge facing up, stab all layers of the abdominal wall along the linea alba. Observe the stab incision to determine if you are along the linea alba or off midline (rectus muscle visible). A slight paramedian incision may result in the external rectus fascia and muscle being cut/exposed, while the internal rectus facia and peritoneum remains intact. In this instance, a separate incision through the internal fascia/peritoneum is required in order to enter the abdominal cavity. If you find you have stabbed along the linea alba or very close to the linea alba, proceed by extending the incision with a pair of Mayo scissors in a cranial and caudal direction along the linea laba; correcting a mildly off midline stab as you incise further. Tenting the abdominal wall while you extend the incision will limit the risk of trauma to internal organs. Digital palpation (or palpation with a closed Mayo scissor) through the initial incision may help determine if there are any intraabdominal adhesions prior to extending the incision further. If you have stabbed farther away from the linea alba, you might want to consider a new stab incision to limit tissue trauma and hemorrhage. Incising along the linea alba creates less hemorrhage and allows for easiest closure. The falciform ligament is typically located cranial to the umbilicus and will not be encountered through this incision.
< Skin and Subcutaneous Incision Find the Left Uterine Horn >