🔪 SURGICAL BLADES
Scalpel blades are attached to a handle (commonly Bard-Parker handle) and are used for
making incisions.
Each blade number has a specific shape and use.
⚙️ 1. Scalpel Handles
Handle No. Common Use
No. 3 Most common handle — for No. 10–15
blades
No. 4 Used for larger blades (No. 20–25) — for
major surgery
No. 7 Long, pencil-like handle — used in
narrow/deep areas (e.g. ENT, vascular)
🔢 2. Blade Types and Uses
Blade No. Shape Common Uses
10 Large, curved edge For large skin incisions
(e.g., laparotomy)
11 Triangular with pointed tip For stab incisions, draining
abscess, or arteriotomy
12 Hooked curved cutting edge For ENT surgery, mucosal
incisions, or suture removal
15 Small curved edge For short, precise incisions
(e.g., plastic surgery, hand
surgery)
20–25 Larger versions of No.10 For major operations —
e.g., amputation, thoracotomy
22 Broad curved edge Used in major abdominal
and orthopedic surgeries
⚕️ Blade Handling
● Blade is mounted on handle using artery forceps (never by hand).
● Held like a pen for precision cuts or like a table knife for long incisions.
● Always cut away from yourself and assistant.
✂️ SURGICAL INCISIONS
An incision is a planned surgical cut made through skin and underlying tissues to gain access
to deeper structures.
🔹 1. Types by Direction
Type Description Example
Vertical incision Parallel to body midline Midline laparotomy
Transverse incision Perpendicular to midline Pfannenstiel (C-section)
Oblique incision At an angle Kocher’s incision (for gall
bladder)
Curved incision Curvilinear McBurney’s incision
(appendix)
Chevron (rooftop) Bilateral subcostal For liver or pancreatic
surgery
🔹 2. Types by Location and Use
Incision Location Use
Midline incision From xiphoid to pubis through Most common — for
linea alba exploratory laparotomy
Paramedian incision Parallel to midline, 2–5 cm For access to one side of
lateral abdomen
McBurney’s incision Oblique in right lower Appendectomy
quadrant
Gridiron incision Muscle-splitting modification Appendectomy
of McBurney
Pfannenstiel incision Curved transverse above Cesarean section, pelvic
pubic symphysis surgeries
Kocher’s (right subcostal) Below right costal margin Gall bladder, CBD
exploration
Left subcostal incision Below left costal margin Spleen
Rutherford Morrison Oblique in right/left iliac fossa Renal transplant, pelvic
incision surgery
Battle’s incision Oblique lateral to rectus Appendectomy (alternative)
Chevron incision Bilateral subcostal joined in Liver transplant
midline
Lanz incision Transverse in right iliac fossa Cosmetic appendectomy
Maylard incision Transverse, through rectus Gynecological surgery
muscle
Thoracotomy incision Over intercostal space Chest/lung operations
Lumbotomy incision Posterior flank region Kidney surgery
🔹 3. Incision Principles
✅ Should give adequate exposure
✅ Should minimize tissue trauma
✅ Should avoid major vessels and nerves
✅ Should allow good closure
✅ Should be cosmetically acceptable
🔹 4. Skin Tension Lines (Langer’s Lines)
● Incisions made parallel to Langer’s lines heal better and leave minimal scar.
📚 Mnemonic for Common Incisions
"Many People Make Perfect Knives For Real Beauty"
● Midline
● Paramedian
● McBurney
● Pfannenstiel
● Kocher
● Flank (Rutherford Morrison)
● Roof-top (Chevron)
● Battle
🩺 I. Abdominal Incisions
These are made to access abdominal organs.
Selection depends on organ location, exposure needed, and cosmetic outcome.
1️⃣ Midline Incision
➡ Location: Along the linea alba, from xiphoid process to pubic symphysis.
➡ Types:
● Upper midline – xiphoid → umbilicus
● Lower midline – umbilicus → pubic symphysis
➡ Advantages: Quick, minimal bleeding, can extend easily.
➡ Uses:
● Exploratory laparotomy, bowel surgery, trauma, emergency access.
2️⃣ Paramedian Incision
➡ Location: Parallel to midline, ~2–5 cm lateral (right or left).
➡ Muscles: Rectus sheath incised; rectus muscle retracted laterally.
➡ Advantages: Stronger closure.
➡ Disadvantages: Time-consuming, more bleeding.
➡ Uses:
● Stomach (left paramedian)
● Gall bladder or biliary tract (right paramedian)
3️⃣ Transverse Incision
➡ Location: Horizontally across abdomen.
➡ Advantage: Better cosmetic result, less pain.
➡ Uses:
● Common in pediatric, gynecologic, and pelvic surgeries.
4️⃣ Oblique Incision
➡ Direction: Diagonal cut across muscle fibers.
➡ Example:
● Kocher’s incision: Right subcostal, for gall bladder/CBD.
● Battle’s incision: Oblique, for appendix (alternate to McBurney).
5️⃣ McBurney’s (Gridiron) Incision
➡ Location: Right lower quadrant; one-third from ASIS to umbilicus.
➡ Technique: Muscle-splitting (external & internal oblique, transversus).
➡ Uses: Open appendectomy
➡ Advantage: Minimal muscle damage; strong closure.
6️⃣ Lanz Incision
➡ Location: Transverse incision in right iliac fossa, at McBurney’s point level.
➡ Use: Cosmetic alternative for appendectomy.
7️⃣ Pfannenstiel Incision
➡ Location: Curved, 2–3 cm above pubic symphysis.
➡ Direction: Transverse, concave upwards.
➡ Use: Cesarean section, pelvic surgeries, bladder operations.
➡ Advantage: Excellent cosmetic healing.
8️⃣ Maylard Incision
➡ Location: Transverse suprapubic, cutting rectus muscles.
➡ Use: Gynecological and pelvic surgeries needing more exposure.
9️⃣ Rutherford Morrison (Flank/Modified Iliac) Incision
➡ Location: Oblique in right or left iliac fossa, muscle-cutting.
➡ Use: Renal transplant, pelvic access.
🔟 Subcostal Incision (Kocher’s and others)
➡ Location: 2–3 cm below and parallel to costal margin.
➡ Types:
● Right subcostal (Kocher’s) → Gall bladder, CBD.
● Left subcostal → Splenectomy.
● Bilateral subcostal (Chevron) → Liver or upper abdominal surgery.
11️⃣ Chevron (Rooftop) Incision
➡ Shape: Bilateral subcostal joined in midline forming “Λ” shape.
➡ Use: Liver resections, liver transplant, pancreas surgery.
➡ Modified form: Mercedes-Benz incision (with vertical midline extension).
12️⃣ Rooftop (Mercedes-Benz) Incision
➡ Shape: Chevron incision + vertical midline limb upward.
➡ Use: Liver transplant (standard for recipient access).
13️⃣ Flank (Lumbotomy) Incision
➡ Location: Posterior-lateral abdominal wall below 12th rib.
➡ Use: Kidney operations (open nephrectomy).
➡ Advantage: Retroperitoneal access; no entry into peritoneal cavity.
14️⃣ Transverse Upper Abdominal Incision
➡ Location: Across epigastrium, between costal margins.
➡ Use: Stomach, duodenum, pancreas, liver surgeries.