Presented by:
Tanner Adams-White
Affiliations:
UBC – Fraser Health Authority
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What Is The Maylard Incision: Expanding Minimally Invasive Options in Open surgery
The Maylard incision is a transverse abdominal incision used in open pelvic and gynecologic surgery when wider surgical exposure is needed than a standard Pfannenstiel incision can provide. It offers broad access to the pelvis while maintaining a low, horizontal abdominal incision. Here’s what it involves:
- Abdominal Incision: A transverse skin incision is made in the lower abdomen, generally above the pubic area.
- Fascial Opening: The abdominal fascia is opened transversely to provide access to the underlying rectus muscles.
- Rectus Muscle Division: Unlike a Pfannenstiel incision, the rectus abdominis muscles are divided transversely rather than separated along the midline.
- Vessel Management: The inferior epigastric vessels are identified and carefully ligated or controlled before the rectus muscles are divided.
- Pelvic Exposure: Opening the muscle layers provides a wider operative field and improved access to the pelvic sidewalls and deeper pelvic structures.
- Surgical Closure: Following the procedure, careful closure of the abdominal wall is performed with attention to hemostasis and restoration of tissue layers.
The Maylard incision can provide the additional exposure needed for complex open pelvic surgery while retaining the cosmetic advantages of a transverse lower abdominal incision.
What are the risks of The Maylard Incision: Expanding Minimally Invasive Options in Open surgery
Although the Maylard incision can provide excellent surgical exposure, dividing the abdominal muscles and managing nearby blood vessels introduces specific risks.
- Bleeding: Injury to the inferior epigastric vessels or other abdominal wall vessels can cause significant bleeding or hematoma formation.
- Muscle Injury and Pain: Division of the rectus muscles may contribute to increased postoperative discomfort and temporary abdominal wall weakness.
- Nerve Injury: Nearby nerves can be damaged during the incision or dissection, potentially causing numbness, altered sensation, or persistent pain.
- Wound Complications: Infection, wound separation, seroma, or delayed healing can occur following open abdominal surgery.
- Incisional Hernia: Weakness at the surgical site can occasionally lead to the development of an incisional hernia.
- Injury to Surrounding Structures: The bladder, bowel, blood vessels, or other pelvic structures may be injured during abdominal entry or surgery.
- Anesthetic and General Surgical Risks: As with other open procedures, risks include blood clots, anesthesia-related complications, and postoperative infection.
Careful identification of the inferior epigastric vessels, meticulous surgical technique, and appropriate abdominal wall closure help reduce these risks while allowing improved access to the pelvis.