a. This incision differs from the Maylard in that the rectus muscle is not transected through its corpus; instead, it is cut across its tendinous origin on the pubic symphysis.
b. The muscle is then reflected cranially.
c. Following the surgery, the tendinous insertion is reattached to the pubic symphysis.
d. This incision is strong and allows adequate exposure to the pelvis.
e. Like the Maylard it is limited in its exposure of the upper abdomen.
(1) A Cherney incision begins like the Maylard and Pfannenstiel in that the skin and superficial fascia are cut down to the level of the rectus fascia.
(2) The rectus fascia is then nicked in the midline and the incision is extended transversely with sharp dissection as described,
(a) At this point, the Cherney differs from the Maylard in that the inferior leaf of the split fascia is grasped with two Kocher clamps, is elevated, and is dissected off the rectus abdominis and pyramidalis muscles using either sharp or blunt dissection.
(b) This dissection is carried down to the level of the pubic symphysis, where the aponeurosis of the rectus and pyramidalis muscles are identified.
The Cherney incision. A, A transverse elliptical skin incision is made through the skin and subcutaneous tissue. The tendon of the rectus abdominis muscle and pyramidalis is transsected on each side as shown by the broken line. B, The muscles are reflected cranially, and the peritoneum and transversalis fascia are picked up between forceps and incised transversely.
cont’d c, At the conclusion of surgery, the tendon of the rectus muscle is attached to the undersurface of the rectus sheath by several interrupted stitches, and the original incision in the rectus aponeurosis is closed with a continuous running suture. The skin incision is closed with staples or a subcuticular closure.
(3) The tendon is then incised with Mayo scissors, releasing the muscles from their origin on the pubic symphysis.
(4) This allows the muscles to be retracted superiorly, and out of the operative field.
(5) Once retracted, the transversalis fascia and peritoneum can be entered as described.
(6) Following the operation, the tendon of the rectus and pyramidalis muscles should be reattached to the pubic symphysis using interrupted permanent suture.
(7) Because this incision reattaches the muscle to the pubic symphysis, the rectus muscle cannot retract cranially into the rectus sheath. Therefore, a Pfannenstiel incision, if found to be inadequate intraoperatively, can be converted to a Cherney without compromising the integrity of the midline musculature.