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Question 15
Anatomy → Region
Classification
Question
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A modified Pfannenstiel incision is used for pelvic surgery. The incision is relatively time consuming, has limited extensibility and carries a recognised risk of injury to the inferior epigastric vessels. Which incision is described?
Question Stem
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Options
A
Joel-Cohen incision
B
Cherney incision
C
Maylard incision
D
Kustner incision
E
Rutherford Morison incision
Explanation
The Kustner incision is a modified Pfannenstiel incision. Its skin incision is slightly curved, begins below the level of the anterior superior iliac spine and extends just below the pubic hairline. It is more time consuming, has limited extensibility and may damage the inferior epigastric vessels. These features distinguish it from the Joel-Cohen incision, which is a straight transverse incision used commonly for caesarean section, and from the Cherney incision, which transects the rectus muscles at their insertion. The Maylard incision also cuts the rectus muscles transversely to provide wider pelvic access, while the Rutherford Morison incision is an oblique lower abdominal incision along the inguinal ligament. The combination in the question therefore identifies Kustner.
Option Validity
A) Joel-Cohen is a straight transverse incision and is not described as the modified Pfannenstiel incision with these limitations.
B) Cherney involves transection of rectus muscles at their insertion and upward retraction.
C) Maylard is a transverse muscle-cutting incision designed for wider pelvic access.
E) Rutherford Morison is an oblique lower abdominal incision along the inguinal ligament.
Further Reading
Part 1 MRCOG Revision Notes and Sample SBAs. Cambridge University Press, 2020. Section 1: Anatomy, Chapter 1. https://doi.org/10.1017/9781108644396