Incisions In Surgery – How Does A Surgeon Decide Where To Put The Incision?

How do surgeons decide how to make an incision? Many factors go into choosing the right incision for surgery. I’ll share three I use to make my decision.

Purpose of the surgery

Am I taking out a tumor?

Releasing the carpal tunnel?

Fixing a broken bone?

Obviously the location on the arm is an important factor in choosing where to put the incision. However, the incision may need to be longer than you think if I need to see and protect a nerve or artery.

For instance, the incision to take out a small, pea-sized cyst on the palm side of the finger is bigger than the cyst for this reason. I have to see the nerves to protect them while I take out the cyst.

Getting access to the target

Incisions may be directly over the bone or joint, or may be over to one side of the same area.

For instance, on the back of the elbow, it’s better to put an incision to the side of the midline so when you rest the elbow on a hard table, it’s not putting pressure on the scar.

Sometimes an indirect approach is better, to avoid pressure on the body part or to hide a scar.

Minimizing scarring during surgery

In the picture below you can see how the wrinkles or creases in the wrist are lined up. They run across the wrist.

The incision runs parallel to these skin lines, called Langer’s lines. This tends to minimize scar width and thickness.

Sometimes the orientation (which direction I make the cut) of the incision is designed to minimize the scar.

The incision above has completely healed. There is still some dried blood left over from the surgery. You can see the lighter area where some little butterfly tapes were taken off.

The sutures are running under the skin, and sticking out either end. They’re ready to be taken out.