Transverse Incisions in Gynecologic Surgery: Pfannenstiel, Maylard, and Cherney
Three classic transverse (horizontal) abdominal incisions used in gynecologic and obstetric surgery:
- Pfannenstiel incision (Kerr/Pfannenstiel): Curved, 2–3 cm above pubic symphysis. Most common for C-section, hysterectomy. Rectus sheath opened transversely; muscles separated vertically. Cosmetic, low pain, good healing.
- Maylard incision: Transverse rectus abdominis muscle division at the arcuate line. Wider exposure to upper pelvis. Higher risk of hematoma, nerve injury, hernia.
- Cherney incision: Transverse rectus detachment from pubic bone with reattachment. Excellent exposure to space of Retzius and pelvic sidewall. Used for radical hysterectomy, urethral surgery. Requires meticulous repair.
Selection Factors
- Required exposure (pelvic vs. abdominal)
- Patient habitus
- Surgeon experience
- Cosmetic concerns
- Prior incisions
Pfannenstiel remains the workhorse for most pelvic surgery. Maylard and Cherney are reserved for cases needing extended access.
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