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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

Pfannenstiel Incision

The Pfannenstiel incision has become popular in the past decade for cosmetic reasons. This is particularly true in younger women having surgery for benign gynecologic and pelvic problems. If properly placed, it is generally concealed by regrowth of pubic hair.

The purpose of the technique is to provide a cosmetic incision for pelvic surgery.

Physiologic Changes. The Pfannenstiel incision transects neurovascular pathways in the skin of the abdominal wall and frequently requires partial or compete transection of the rectus abominis muscle. It is rarely associated with incisional hernia, has a low incidence of wound dehiscence, and heals without significant scarring. The latter fact may be due to the copious blood supply in the mons pubis.

Points of Caution. A Pfannenstiel incision should never be used in oncologic surgery. It does not give exposure to the upper abdomen and provides only limited exposure to aortic and lymph nodes for their analysis and dissection. Care must be taken to avoid incidental laceration of the inferior epigastric artery and vein on the lateral margin of the rectus muscles. If the muscles are to be transected, the epigastric artery and vein should be identified, clamped, and ligated prior to transection of the muscle. In addition, care should be taken with regard to the point of entry into the peritoneum. If the incision is made too low, the bladder can be entered.

Hemostasis is particularly important during this incision. The vascularity of the mons pubis increases the risk of hemorrhage, formation of hematoma, and infection. The surgeon should ensure that the incision is dry before closure of the wound. If there is any question, a small suction drain should be left in the incision for 24-48 hours.


The patient's position for this operation can be lithotomy, supine, or modified dorsal supine lithotomy. The latter is shown here.

The Pfannenstiel incision is semicircular and is made slightly above the mons pubis for a length of about 12 cm. Care must be taken to ensure that hemostasis is complete prior to entering the peritoneal cavity. The rectus fascia is opened transversely.

After the rectus fascia is opened, the rectus muscles are separated and dissected off the peritoneum. If the rectus muscles cannot be separated sufficiently by lateral retraction, they should be transected. In general, the muscles are easier to separate in patients who have had a previous term pregnancy. In some patients with strong, tight rectus muscles, adequate exposure may not be achieved without transection of the muscle. If the muscle is to be transected, the inferior epigastric artery and vein on the lateral border of the muscle must be clamped, incised, and ligated prior to cutting the muscle.

The peritoneum is picked up between tissue forceps and opened with either a longitudinal or a transverse incision.

Copyright - all rights reserved / Clifford R. Wheeless, Jr., M.D. and Marcella L. Roenneburg, M.D.
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