A surgeon needs a transverse abdominal incision for cesarean section in a woman with a large fibroid requiring wide access. Which incision specifically involves dividing the rectus abdominis muscles transversely near their insertion?

• A Maylard incision ✓
• B Joel-Cohen incision
• C Pfannenstiel incision
• D Midline vertical incision

Explanation

The Maylard incision is a transverse suprapubic incision in which both rectus abdominis muscles are cut transversely after ligating the inferior epigastric vessels, giving wider access than a Pfannenstiel, where the recti are only retracted laterally in the fascial opening. The Joel-Cohen is placed higher than Pfannenstiel and also spares the muscle. C midline vertical incision provides access but does not divide the recti transversely. The Cherney incision similarly divides the rectus tendinous insertions at the pubis, a related alternative.

Reference: Te Linde's Operative Gynecology, 12th ed.

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