Comparison Between Different Incisions
Kishore et al. in their series have compared three incisions, namely, Pfannenstiel, midline and iliac fossa reduced in Pfannenstiel incision compared to iliac fossa. The parameters compared included warm ischaemia time, length of incision and wound complications. They found that the warm ischaemia time was significantly less in Pfannenstiel incision compared with iliac fossa incision. The length of the incision was less in midline group in comparison to all the three groups. The midline incision group had significantly larger graft extraction complications. The complications included perinephric haematoma due to excessive traction on the fat .
Risk Reduction Strategies for Safe Extraction
- 1. Never open the peritoneum prior to securing the vessels. A rent in the peritoneum causes loss of pneumoperitoneum.
- 2. The surgeons hand should grasp the grasper holding the graft. This in turn helps in preventing graft loss.
- 3. The iliac fossa incisions are preferred in obese individuals; Pfannenstiel incisions are cosmetically superior, while umbilical incision helps in single-port approach.
- 4. The perigraft fat acts as a handle to retrieve the graft. While extracting the graft, the ports should be removed to prevent laceration of the graft.