Interneural and intervascular extension for increased exposure in midline vertical incisions.

In instances in which wide upper lateral abdominal exposure is required, standard midline incisions are occasionally inadequate. The typical invered "U" incision violates the nerve and blood supply to the abdominal wall. An interneural and intervascular incision which is used either as an extension of the midline incision or bilaterally as the primary incision is described herein. The interneural and intervascular extension begins at the costal margin and curves medially with severance of the full thickness abdominal wall to join the vertical midline incision. This extension raises a triangular flap of abdominal wall with a base on the costal cartilage and apex at the junction of the two incisions. In a series of seven patients, no interneural and intervascular incision resulted in wound hernia or delayed wound healing postoperatively. This approach provides superior lateral abdominal exposure and by paralleling nerve and vascular distribution, follows sound anatomic principles for minimizing pain and promoting subsequent wound healing.