Board Review
Basic Science
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Type of Incisions: McBurney
Contributed by Mika Sinanan, MD
and his staff at the University of Washington Medical School

McBurney Incision

When the diagnosis of appendicitis is clear, the McBurney incision is one of two incisions used for appendectomy. The McBurney's Point is located one third of the distance from the anterior superior iliac crest to the umbilicus. This is the classic location of the appendix. Since the appendix is a mobile part of the body, it may be found in various places in the right lower quadrant. For best exposure, incision should be adapted after physical examination at the maximum point of tenderness. This incision is usually made parallel with the course of the fibers of the external oblique fascia, one or two inches cephalad to the anterior superior spine of the ilium.

The Rocky-Davis incision provides another option. Unlike the McBurney incision, it is a straight transverse at the skin and splits the muscle. Again, either incision is made as long as necessary to achieve adequate exposure. Thin people require a smaller incision than obese patients. Those patients with an anterior appendix are usually easier to manage through a small incision, as opposed to retrocecal appendices which require an extended incision.

Extending the right lower quadrant incision for greater exposure usually requires either medial extension opening the rectus fascia and displacing the rectus muscle medially, or a second midline incision. The second midline incision may be considered in patients with pathology that extends beyond the right lower quadrant.

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