Download Organization of the antero

Organization of the
antero-lateral abdominal
wall
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The abdomen
• The abdomen is the part of the trunk between the thorax
and the pelvis.
• Superiorly: Xiphoid process; Costal cartilages of the 7th
and 10th ribs.
• Inferiorly: Iliac crest; Anterior superior iliac spine;
• Inguinal ligament. Pubic tubercle, pubic crest and pubic
symphysis.
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The abdomen…
• The abdomen may be
divided
into
4
quadrants i.e Right
and
left
upper
quadrants
• Right and left lower
quadrants
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The abdomen…
• Clinicians refer to nine regions of the abdominal cavity to describe the
location of abdominal organs, pains, or pathologies
• The nine regions are delineated by four planes:
• Two sagittal (vertical), the midclavicular planes that pass from the
midpoint of the clavicles (approximately 9 cm from the midline) to the
midinguinal points, midpoints of the lines joining the anterior superior
iliac spine and the superior edge of the pubic symphysis on each side.
• The two transverse (horizontal) planes, Subcostal plane joining the
most inferior points of the costal margins, and passing at L3.
• Transtubercular plane, joining the tubercles of the iliac crest and the
body of the L5 vertebra
• The transpyloric plane, extrapolated midway between the superior
borders of the manubrium of the sternum and the pubic symphysis
(typically the L1 vertebral level)
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Nine regions of
the abdominal cavity
Inguinal
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Inguinal
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Abdominal Surgical Incisions
• Surgeons use various incisions to gain access to the abdominal
cavity. When possible, the incisions follow the cleavage lines
(Langer lines) in the skin
Langer lines
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Abdominal Surgical Incisions
• Longitudinal Incisions
• Midline incisions can be made rapidly without cutting muscle,
major blood vessels, or nerves. They cut through the fibrous
tissue of the linea alba, superior and/or inferior to the umbilicus.
Because the linea alba transmits only small vessels and nerves to
the skin, a midline incision is relatively bloodless and avoids
major nerves
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Abdominal Surgical Incisions…
• Oblique and Transverse Incisions
• Gridiron (muscle-splitting) incisions are often used
for an appendectomy. The oblique McBurney incision is
made at the McBurney point, approximately 2.5 cm
superomedial to the ASIS on the spinoumbilical line.
This incision is currently less popular than an almost
transverse incision in the line of a skin crease
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Abdominal Surgical Incisions…
• Transverse incisions
• Suprapubic (Pfannenstiel) incisions (bikini•incisions)
are made at the pubic hairline. These incisions and
horizontal with a slight convexity and are used for
most gynecological and obstetrical operations (e.g., for
cesarean section and removal of a tubal pregnancy).
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Abdominal Surgical Incisions
• High-Risk Incisions
• High-risk incisions include pararectus and inguinal incisions.
Pararectus incisions along the lateral border of the rectus sheath
are undesirable because they are likely to cut the nerve supply to
the rectus abdominis. Blood supply from the inferior epigastric
artery also may be compromised.
• Inguinal incisions for repairing hernias may injure the
ilioinguinal nerve directly or it may be inadvertently included in
the suture during closure of the incision. In such cases, people
may feel pain in the L1 dermatome region, which includes the
scrotum (or the labium majus).
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Applied anatomy
• Incisional Hernia
• An incisional hernia is a protrusion of omentum (a fold of peritoneum)
or an organ through a surgical incision. Surgeons who make incisions
based on a thorough knowledge of anterolateral abdominal wall
anatomy will only occasionally have to deal with this problem.
However, if the muscular and aponeurotic layers of the abdomen do
not heal properly, an incisional hernia can result. Factors predisposing
a patient to incisional hernia include advanced age or debility of the
patient, obesity, and postoperative wound infection.
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