Maylard’s incision: how to make an easy incision for complex pelvic abdominal surgery

Peritoneal hernia following abdominal hysterectomy: A case report

“…The Maylard incision, used in this case, is a transverse incision indicated during hysterectomy when additional exposure of the abdominal, pelvic, and retroperitoneal cavities is required [ 15 , 16 , 17 ]. It is associated with a low rate of hernia formation and low rate of mortality, and, ordinarily, the peritoneum is not closed with this surgical approach [ 18 ]. The use of knots and sutures during peritoneal closure in transabdominal preperitoneal laparoscopic hernia repair has been rarely associated with herniation; however, factors such as previous abdominal surgery or inflammation are more likely involved [ 19 , 20 ].…”

The transverse-vertical incision (Alazzam hybrid incision)

“…While both the Cherney and Maylard incisions act as a feasible alternative to midline laparotomy due to increased pelvic exposure [14], the Cherney incision is twice as fast with an average completion time of 1 to 2 min, spares the inferior epigastric resulting in less bleeding and hematoma formation, and is muscle "separating" as it cuts parallel to the rectus muscle fibers providing greater wound strength [3]. On the other hand, Maylard incisions, despite being muscle cutting, retain the advanced of transverse incisions and are considered a suitable alternative to laparoscopy and in women with cervical cancer and complex pelvic conditions due to its excellent exposure of the pelvic sidewalls [15]. The Alazzam hybrid incision retains the advantages associated with both transverse and midline incisions while avoiding their inherent limitations.…”

Vascular Anatomy and Variations of the Anterior Abdominal Wall – Significance in Abdominal Surgery

“…The level of the incision depends on the type of surgery and BMI (body mass index) of the patient. The Maylard's incision should be avoided in a deep skin crease (Maylard, 1907;Burger et al, 2002;Baggish and Karram, 2006;Rock et al, 2008;Ortiz Molina et al, 2020). The transverse incision is carried down through the skin, subcutaneous fat, superficial fascia, and the aponeurosis of rectus abdominis muscle.…”

“…The transverse incision is carried down through the skin, subcutaneous fat, superficial fascia, and the aponeurosis of rectus abdominis muscle. Lateral limit is the external edge of the rectus muscles or the greater or lesser part of the aponeurosis of the oblique abdominis muscle (Baggish and Karram, 2006;Ortiz Molina et al, 2020). Consequently, the inferior epigastric vessels are identified, isolated, doubly clamped, cut and ligated.…”

“…The underling transversalis fascia and parietal peritoneum are incised transversely along the length of the incision. During closure, an approximation of the rectus abdominis muscles is not necessary (Baggish and Karram, 2006;Ortiz Molina et al, 2020). This type of incision is suitable for radical hysterectomy, pelvic lymphadenectomy and pelvic exenteration as it provides excellent access to the pelvic retroperitoneum.…”