The Pfannenstiel-approach - from 1900 until 2024

Area of Science:

• Orthopedic Surgery
• Surgical Techniques

Background:

• The Pfannenstiel approach is commonly used for pelvic ring injuries, particularly symphyseal plating.
• Its original description was for gynecological cesarean sections, involving transverse rectus abdominis muscle dissection.
• Current surgical practice has diverged from this classical method.

Purpose of the Study:

• To analyze the evolution of the Pfannenstiel approach in treating pelvic ring injuries.
• To highlight the shift towards a modified supra-symphyseal crosscut technique.
• To propose renaming the approach to reflect current surgical practice.

Main Methods:

• Review of surgical literature and common practices for pelvic ring injury treatment.
• Comparison of the original Pfannenstiel approach with current techniques used by pelvic surgeons.
• Analysis of fascial incision methods (transverse vs. longitudinal).

Main Results:

• Current pelvic surgery trends show a move away from the original transverse rectus abdominis dissection.
• A supra-symphyseal crosscut approach with a longitudinal fascial incision is increasingly favored.
• Transverse fascial incisions of the rectus sheaths are rarely performed.

Conclusions:

• The term "Pfannenstiel approach" is no longer accurate for current symphyseal plating techniques.
• The modified supra-symphyseal crosscut approach, as described by Küstner, better represents current practice.
• Renaming the approach to "modified Pfannenstiel approach" is recommended for clarity.