Fundamentals of Incisions and Skin Closures

Abstract

This chapter will address the principles that guide the decision of where to place and how to close common incisions utilized in routine general surgical procedures. A strong understanding of anatomy, wound behavior, and healing will herald successful outcomes. The major goal in choosing the optimal surgical incision is assuring adequate visualization. There are a wide range of general surgery operative sites and incisions. Common abdominal incisions include the vertical midline, paramedian, transverse, oblique, and thoracoabdominal. Additionally, the retroperitoneum, cervical area, and breast are specialized sites that will be discussed in this chapter. The principles of wound closure can be summarized into three major components: achieving primary skin closure, minimizing wound-healing complications, and optimizing cosmesis. Additional elements of incision closure including primary closure, delayed closure, wound complications, and cosmesis will also be discussed.