Caesarean deliveries by pfannenstiel versus joelcohen. Comparison between the joelcohen and pfannenstiel incisions in. First reported in 1900 by german gynecologist hermann johannes pfannenstiel, the pfannenstiel incision was used for gynecological surgery on women. Pfannenstiel incision synonyms, pfannenstiel incision pronunciation, pfannenstiel incision translation, english dictionary definition of pfannenstiel incision. Rattoothed forceps were used to assist with manipulation of the tissues. Abdominal surgical incisions for caesarean section in a caesarean section operation, there are various types of incisions in the abdominal wall that can be used. All adult women, operated on between 1986 and 1992 using a pfannenstiel incision and not having had another lower abdominal incision other than for laparoscopy, were invited for followup at the. Abdominal surgical incisions gridiron pfannenstiel. The pfannenstiel kerr technique consists of the pfannenstiel incision figures, which is a transverse skin incision, two fingers above the symphysis pubis, which is extended in the direction of the anterior superior iliac spine asis, and ends 23 cm medial to asis on both sides. It derives instead from the surname of hermann johannes pfannenstiel 18621909, the german gynecologist who invented the technique in 1900. In his book treatise on caesarean section published in 1581, roussett. The pfannenstiel family name was found in the usa between 1880 and 1920.
The original pfannenstiel incision is discussed including the technique, history, current indications, advantages, and disadvantages. Hermann johann pfannenstiel and the pfannenstiel incision. Caesarean section incision in abdomen revisited internet. There are many ways to perform a caesarean section. Pfannenstiel versus maylard incision for gynecologic surgery core. Surgical access incisions statpearls ncbi bookshelf. Kansas had the highest population of pfannenstiel families in 1880. Once the skin is opened it exposes the underlying fat, which may have blood vessels that have to be burned or tied off. In the classic pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba is opened vertically. These include vertical and transverse incisions, and there are variations in the specific ways the incisions can be undertaken. The german surgeon hermann johann pfannenstiel 18621909 contributed much to obstetrics and gynecology. Improve your surgical skills by following this elearning module. This web page shows only a small excerpt of our pfannenstiel research.
A firm favourite of obstetricians for accessing the gravid uterus for which a curvilinear incision is made through the skin and subcutaneous fat, then a longitudinal incision made in the linea alba. Pfannenstiel incision an overview sciencedirect topics. The unstoppable keeper by lutz pfannenstiel and a great selection of related books, art and collectibles available now at. Limitations include lack of upper abdominal exposure, increased risk of hematoma or seroma formationespecially in the face of. The first step to getting a pfannenstiel incision, often known as a bikini incision, is a cut in the abdominal skin, its just above the hair line. This course provides a step by step approach, procedural anatomy and a test. Pfannenstiel incision for radical retropubic prostatectomy. We have a ringside seat in the operating theater of university college hospital in london as worldrenowned victorian surgeon robert liston performs a remarkable amputation in thirty seconds. This began to change following the publication in 1598 of jacques guillimeaus book on midwifery in which he introduced. This study investigated the effect of a prior pfannenstiel incision on venous anatomy of the lower abdominal wall. Another 72 words 5 lines of text are included under the topic early pfannenstiel history in all our pdf extended history products and printed products wherever possible.
Pfannenstiel incisions with history of repeat caesarian sections were not associated. The history of the 31st bombardment squadron h by joanne pfannenstiel emerick. Pfannenstiel incision is considered as the common method in csection. When a laparoscopy becomes a laparotomy editors note. The most current and the previous cesarean operations performed by the surgeons in the study involved cutting the skin and the subcutaneous tissue transversely at 2 cm above the pubic bone pfannenstiel incision under general and spinal anesthesia, then blunt dissecting the rectus sheath with a finger, and entering the abdomen. Midline incisionsa vertical incision which follows the linea alba. Also used by general and urological surgeons for some pelvic procedures such as radical open prostatectomy or cystectomy. In 1880 there were 28 pfannenstiel families living in kansas.
The pfannenstiel is a transverse lower abdominal incision that is made. Pdf the influence of pfannenstiel incision scarring on deep. The pfannenstiel incision is a horizontal skin incision made just above the symphysis pubis pubic bone. Maylards incision it is a transverse muscle cutting incision it is placed above but parallel to the traditional placement of pfannenstiel incision. The lateral border of the rectus sheat should be reached.
Joelcohen incision should be made in a linear fashion approximately 23 cm above the traditional placement of the pfannenstiel incision. It is the most popular skin incision made for a cesarean section, and it is also known as the bikini cut. The pfannenstiel incision is made transversely in the maternal abdomen. The influence of pfannenstiel incision scarring on deep. Pronunciation of pfannenstiel with 2 audio pronunciations, 1 meaning, 1 translation, 5 sentences and more for pfannenstiel.
The long history of cs may explain the availability of several variants in. The joelcohen incision has advantages compared to the pfannenstiel incision. Although pfannenstiel means panhandle in german, the name of the pfannenstiel incision does not derive from the incisions shape or location. The name of the method was derived from hermann johannes pfannenstiel. There are right subcostal incision and left subcostal incision or may be carried across the midline as bilateral sub costal incision. This was about 88% of all the recorded pfannenstiel s in the usa.
He is remembered in medical history for the incision transverse suprapubic incision that. In his book treatise on caesarean section published in 1581, roussett advised. Abdominal wall incision pfannenstiel incision academy. The german gynecologist hermann johannes pfannenstiel 18621909 invented the technique. Professor joelcohen introduced this incision for abdominal hysterectomy in 1954 and obstetricians have since used this widely to perform caesarean sections. The transverse abdominal incision was modified by alfred maylard in 1907 17 and by joelcohen in 1972.
Exclusion criteria were a post cesarean section pregnancy. A 37yearold woman with pain at the lateral aspect of her. Historic records that elude to the performance of cesarean section date back as. Pfanennstiel incision is the most commonly used incision for cesarean section, but may not be the best. A 1012 cm pfannenstiel incision was made 2 fingers above the pubic bone. In blood and guts, veteran science writer richard hollingham weaves a compelling narrative from the key moments in surgical history. A vertical incision at approximately the right midclavicular line, as would occur if mcburneys incision was extended superiorly, would cut several segmental nerves, resulting in loss of sensation and paralysis of the muscles on the right side, which would in turn cause bulging of the abdominal wall and might necessitate the use of a support belt. The maylard incision is also called the mackenrodt incision. The pfannenstielkerr technique consists of the pfannenstiel incision figures.
The pfannenstiel incision is not a very common approach for radical retropubic prostatectomy rpe. The history of the 31st bombardment squadron h by joanne pfannenstiel emerick 20100503 joanne pfannenstiel emerick on. Pfannenstiel incision medical definition merriamwebster. They studied 34 patients from each group pfannenstiel incision group vs. The incision in the rectus muscles is performed with the help of cautery, scalpel or surgical stapler.
A randomized comparative study on modified joelcohen incision. Excellent cosmetic results, principles of less traumatic surgery, and a rare incisional hernia. Midline vertical incision should be made in the midline and extend from just below the umbilicus to just above the symphysis pubis and may be continued around the umbilicus if more exposure is necessary. Throughout the 19 th century, longitudinal incisions, in all disciplines where abdominal surgery was indicated, were the rule until 1897 when johannes pfannenstiel introduced his transverse incision 2. The skin incision is made just through the skin, and not the subcutaneous tissue. An incision is a fine cut made by a surgeon during surgery. Learn about the abdominal wall incision pfannenstiel an online 3dvideobased course, accredited by the royal college of surgeons of england. Incision placement is higher than a pfannenstiel incision, about 1 inch below a line connecting the anterior superior iliac spines. In the united kingdom, the surgery was first popularised by dr. The midline vertical incision will heal more quickly than a pfannenstiel incision.
Using a pfannenstiel incision, there is a certain lower distance from the port to the area of operation, but we had no difficulties when using the laparoscopic approach, and very beneficial is the. This study compared the modified joelcohen incision with the pfannenstiel incision to. This study compared the modified joelcohen incision with the pfannenstiel incision to evaluate whether techniques to open the abdomen might influence operative time, and maternal and neonatal outcomes. Maylard incision a variation of pfannenstiel incision is the maylard incision in which the rectus abdominis muscles are sectioned transversally to permit wider access to the pelvis. Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis.
The midline vertical incision is a better option for larger patients because more of the uterus is exposed. The first successful cesarean section cs in the new era was performed by ferdinand adolf kehrer in meckesheim. Step 1 fascia is identifiedincised, and incision extended. Pfannenstiel 18621909 and the pfannenstiel incision m. The subcutaneous fat is opened sharply only in the midline to expose the fascia, which is opened in the midline with a knife. The influence of a pfannenstiel scar on venous anatomy of. Pfannenstiel incision should be made in a curvilinear fashion. A wellplanned surgical incision is one of the most crucial steps in any surgical. According to a study by rees and coller 1943, the force required to approximate the edges of a vertical incision in the lower abdomen is 30 times greater than that required to reapproximate a transverse incision. The most pfannenstiel families were found in the usa in 1920. Thus, excellent cosmesis can usually be achieved with the pfannenstiel, maylard, cherney, and transverse supraumbilical incisions. This article discusses the anatomy of the abdominal wall, anatomy of the rectus sheath and common abdominal surgical incision types midline, paramedian, pararectal, gridiron, lanz, pfannenstiel, transverse, kocher the abdominal cavity is an ovoid space bounded cephalad by the diaphragm and inferior thoracic margin, caudally by the pelvic brim, posteriorly by the lumbar spine along with. Use census records and voter lists to see where families with the pfannenstiel surname lived. This book is distributed under the terms of the creative commons.
The ovary was elevated through the incision into the operative field and an oophorocystectomy was performed. After making the incision, the surgeon peels away the layer of fat and tissue beneath the skin. Hermann johannes pfannenstiel 18621909, a german gynecologist who was a native of berlin see pfannenstiel incision jackalyne pfannenstiel born 1947, united states assistant secretary of the navy installations and environment lutz pfannenstiel born 1973, retired german footballer. A pfannenstiel incision involves the obstruction of superficial venous pathways and functional diversion of flow through alternative pathways and adjacent vessels. On infra umbilical transverse incision, exposure is limited when pathology is located in both the upper and lower abdomen. It is the incision of choice for cesarean section and. Within census records, you can often find information like name of household members, ages, birthplaces, residences, and occupations.
Pfannenstiel incision, a type of surgical incision that allows access to the abdomen pfannenstiel mountain, a mountain in the canton of zurich in switzerland pfannenstiel ship, 1998, a ship operated on lake zurich in switzerland. To the authors knowledge, the prevalence of nerve entrapment after the pfannenstiel incision is not known or has never been published. Exposure of the ventral lamina of the rectus sheat and transverse division 23 cm cranial of the symphysis. Abdominal surgical incisions for caesarean section. Caesarean deliveries by pfannenstiel versus joelcohen incision. The midline vertical incision will cause less postoperative pain and allow for earlier ambulation. The pfannenstiel incision is a transverse skin incision. Alternatively, if a minimally invasive approach is being considered, the steps of the procedure are the same as described in the following sections. In this retrospective study, the authors evaluated whether a previous pfannenstiel incision would change perforator flap anatomy based on the deep inferior epigastric perforator flap. In the setting of a prior pfannenstiel incision, patients are brought to the. The illustrations depicting art in this chapter represent the robotic approach. The pfannenstiel incision is perhaps the most frequently used incision in both obstetrics and gynecology, offering satisfactory exposure of the pelvis, excellent postoperative strength, and pleasing cosmetic results. All recruited women were subjected to history taking, general, obstetric examinations and preoperative investigations according to the hospital labour ward protocol, in particular. The incision was developed to avoid hernias or bulges in the abdominal wall that can occur after surgery.
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