Incision, Exposure, Closure

Abstract

Many dangerous surgical mishaps occur because the operative exposure is inadequate. The first step toward obtaining good exposure is a well planned incision of sufficient length. The second step during abdominal surgery requires that the intestines be packed away from the area of operation. If a dissection requires exposure of a large portion of the abdominal cavity, such as for left hemicolectomy or excision of an abdominal aortic aneurysm, it may be necessary to exteriorize the small intestine for the duration of the dissection. The third step is retraction of the wound edges, which is accomplished by having an assistant apply a Richardson retractor to the abdominal wall and deep retractors, such as the Harrington retractor, to deeper structures. In some situations, a mechanical self-retaining retractor, such as the Balfour or the Thompson, may be inserted to separate the lips of a long abdominal incision. For thoracotomy and thoracoabdominal incisions, a Finochietto retractor is excellent for separating the ribs.