Type of Incisions: Lower Midline Contributed by Mika Sinanan, MD and his staff at the University of Washington Medical School Lower midline incisions are used for complex appendicitis, sigmoid colonic, rectal, urological, and gynecological procedures. The muscles at the midline often overlap obscuring the linea alba and making division of the muscle necessary in lower midline incisions. In general, these incisions are well tolerated by patients but are often painful. The weight of the abdominal contents and an obese abdominal wall may put additional strain on such incisions, increasing the risk of hernia formation. For very obese patients, stretching of the abdominal wall can occur. Access to the pelvis is best achieved through an upper abdominal or periumbilical incision in these cases. The principle advantage of the lower midline incision is that the incision can be extended superiorly for processes or operations that involve the upper abdominal viscera or require extra exposure. Similarly, the best exposure of the pelvis is gained by a lower midline incision to the pubis. Video Resource: Incisions, Donald G. Gallup, M.D. 1991 (VHS 28 minutes) available from Ciné-Med's ACS/USSC Educational Library (General Interest Topics) Back to Incision Index Home | Welcome | Clinical Update | Managing Your Residency | Basic Science Board Review | Opportunities | Links | Contributors | Contact Us