Surgical Anatomy of Anterior

Abdominal Wall

Presenter: Dr. A. R. ShaanModerator: Dr. S. B. Choudhary

Surface Topography

Layers of Anterior Abdominal Wall

Superficial Fascia

Superficial Fascia

Fundiform ligament of penis

Anterolateral Muscles

• 5 Muscleso 3 flat muscles

• External Oblique• Internal Oblique• Transersus abdominis

o 2 vertical muscles• Rectus abdominis• Pyramidalis

External Oblique Muscle and Aponeurosis

External Oblique Aponeurosis

“Touch Down Point”

Ligaments from Ext. Oblique Aponeurosis

Medial Crus

Lateral Crus

Cooper’s Ligament (pectineal ligament)

Internal Oblique

Transversus Abdominis

Rectus Abdominis & Pyramidalis

Rectus Sheath

Rectus Muscle and Sheath

Linea Alba

Umbilical Region

Umbilical Ring

Variations in Umbilical ring

Extraperitoneal Fascia

Extraperitoneal Fascia

Comparison of upper and lower three-

fourths of anterior abdominal wallUpper Midline Lower Midline

Linea alba well developed Linea alba poorly developed

Right and left recti well separated Right and left recti close together

Anterior and posterior layers of sheath present

Only anterior layer of sheath present

Aponeurosis of external oblique weak or absent

Aponeurosis of external oblique strong and well developed

Blood supply

• Superficial

• Deep

Superficial Arteries

Deep Arteries

Vessels of anterior abdominal wall

EOP- Ext Oblique Perforators

SCI- Superficial Circumflex Iliac

SE- Superior Epigastric

DCI- Deep Circumflex Iliac

IE- Deep , inferior Epigastric Artery

SIEA- Superficial inferior Epigastric artery

Vascular territories

Lymphatics

Innervation

Dermatomes

Incisions on Abdominal Wall

• “ Pray before surgery, but remember: God will not alter a faulty incision”

• Keeney’s Dictum

Maingot’s 3 requirements:

• Accesibility

• Extensibility

• Security

Varieties of Abdominal incisions

Midline Incisions

Extended Midline Incision

Paramedian Incision

Pararectus Incision (Kammerer-Battle)

Midrectus (transrectus )Incisions

Transverse Incisions

• Upper Abdominal transverse incisions

• Lower abdominal transverse incisions

• Rockey davis incisions

• Pfannelstiel incisions

Pfannelstiel Incision

Extended Transverse incisions

Oblique incisions

• Subcostal incisions and extensions

• Mc Burney incisions and extensions

Complications follwing incisions

• Nerve injury

• Dehiscence

• Incisional hernia

Epigastric (Ventral) Hernia

Umbilical hernia

• Congenital• Upper • Middle • Lower

• Aquired

Congenital umbilical hernia

Umbilicus Layers

Umbilical Herniation

Aquired Umbilical Hernia

Omphalocele ( Exomphalos)

Gastroschisis

Spigelian Hernia

Spigelian hernia Relations

Spigelian Hernia Layers

From every wound there is a scar, and every scar tells a story.A story that says“ I have survived”.

Thank you