Paramedian incision of the abdominal wall

(A) The anterior rectus sheath is opened for the full length of the incision 2 to 3 cm from the midline. The rectus muscle is retracted laterally and the posterior sheath is incised longitudinally under the muscle bed. (B) The lateral paramedian incision is placed near the lateral border of the rectus. When the muscle is retracted laterally, the inferior deep epigastric artery is seen. Finally, the posterior sheath is closed.