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Using either instrument, the principle is to make long smooth strokes through the subcutaneous fat to the fascia. The subcutaneous fat should not be dissected from the fascia because this creates unnecessary dead space. Next, the fascia is incised, and the rectus muscles are separated vertically in the midline. The midline may not be evident in patients with previous abdominal surgery. Identifying where the rectus muscles diverge around the umbilicus or locating the pyramidalis muscles assists i