Checklist for Abdominal Incisions

Preoperative Checklist
(Please indicate   - Done,   X - Not done,   NA – Not applicable) (If at high risk for wound dehiscence and infection, smoking, obesity, history of radiation therapy, diabetes, arteriosclerosis, steroid use, depressed immune system:) (If diabetic:) (If currently smoking:)
 * 1) ____ Inform patient of wound complications and their likelihood of occurrence (wound infection, hematoma, dehiscence, pain, cosmetic changes) along with complications of the primary procedures being performed   (prevent incorrect expectations)
 * 1) ____counsel about increased wound complications (prevent incorrect expectations)
 * 1) ____make sure blood sugars are in optimal control (prevent infection)


 * 1) ____ Advise to discontinue smoking as far prior to procedure as possible (prevent infection, dehiscence)
 * 2) ____Choose type of incision most likely to be used (promote correct expectations)
 * 3) ____Advise to cleanse incision site  prior to procedure with antibacterial soap (prevent infection)
 * 4) ____Advise patient may clip hair evening prior to surgery but no shaving (prevent infection)
 * 5) ____Advise patient about postoperative care including to minimize valsalva with rising from a chair, getting out of bed etc., (prevent dehiscence)
 * 6) ____Keep good glycemic control if a diabetic (prevent infection)

Abdominal wall incision

 * 1) ____ Identify midline and anterior iliac spine and mark on skin the line of the incision if needed (prevent asymmetry of incision)
 * 2) ____ Cut skin incision and subcutaneous tissue with knife, not cautery, and avoid excessive cautery ) (prevent wound infection)
 * 3) ____ Start transverse incision at least 3-5 cm above symphysis pubis (prevent nerve transection)
 * 4) ____ Follow lines of Langer, curving transverse skin incision upward laterally so as not to transect cutaneous nerves (prevent nerve transection)

If removing old scar: If midline incision: If Maylard incision
 * 1) ____excise subcutaneous tissue symmetrically (prevent poor cosmetic scar result)
 * 2) ____Cut rectus fascia only to edge of rectus muscle, avoid lateral extension of incision into internal oblique muscle (prevent nerve transection)
 * 3) ____Cauterize or ligate superficial epigastric vessels on transverse incision even if not bleeding at time of transection (prevent post operative bleeding)
 * 4) ____Cauterize or ligate rectus perforating vessels on Pfannenstiel incision even if not bleeding at time of transection (prevent post operative bleeding)
 * 5) ____ Avoid cutting fascia with cautery or cauterizing large areas of fascia (prevent fasical dehiscensce)
 * 1) ____if incision is extended above the umbilicus, extend around the left of the umbilicus to avoid the ligamentum terres (prevent post operative bleeding)
 * 2) ____ On midline incisions close peritoneum with fascia through the rectus sheath using continuous delayed absorbable or permanent suture (prevent wound dehiscence)
 * 1) ____ Ligate inferior epigastic vessels on Maylard incision (prevent post operative bleeding)

Peritoneal management

 * 1) ____ Enter abdominal peritoneum as cephalad to the fascial incision as possible (prevent bladder injury)
 * 2) ____ Avoid lateral retraction compressing psoas muscle (prevent femoral, genitofemoral and lateral cutaneous femoral nerve injury)
 * 3) ____ On Pfannenstiel or Maylard incisions, close or approximate abdominal peritoneum as a separate layer. (prevent wound dehiscence)

Closing abdomen

 * 1) ____ Observe subfascial space before closing fascia for bleeding (prevent hematoma)
 * 2) ____ Place fascial sutures approximately 1.0 cm from edge of fascia and approximately 1.0 cm apart (prevent wound dehiscence)
 * 3) ____ When closing anterior rectus fascia avoid subcutaneous tissue (prevent nerve entrapment)
 * 4) ____ Approximate fascia without tension on sutures (prevent wound dehiscence)
 * 5) ____ On transverse incisions, reapproximate Scarpa’s fascia superiorly to Scarpa’s fascia inferiorly and Camper’s to Camper’s if present (prevent poor cosmetic scar result)
 * 6) ____ Close subcutaneous tissue with running continuous absorbable suture if 2.0 cm of subcutaneous fat or more (prevent wound infection)
 * 7) ____ Place subcuticular stitches below the dermis (prevent poor cosmetic scar result)
 * 8) ____ Use a hypo allergenic skin adhesive rather than benzoin (prevent poor cosmetic scar result)
 * 9) ____ Close skin with steristrips or bonding (prevent poor cosmetic scar result)
 * 10) ____ Avoid skin staples or if used, remove by 3rd day (decrease postoperative incisional pain) (prevent poor cosmetic scar result)
 * 11) ____Use compression dressing for 48 hours before removing (prevent wound hematoma)