The Abdominal Wall 

is the wall enclosing the abdominal

cavity that holds a bulk of gastrointestinal viscera. A good
amount of area is covered by the abdominal wall. The xiphoid
process and costal margins bound it superiorly, the vertebral
column posteriorly and the upper parts of the pelvic bones
inferiorly. Skin, superficial fascia (subcutaneous tissue),
muscles and their associated deep fascias,
extraperitoneal fascia, and parietal peritoneum together
compose its layers. Among the most common surgical
procedures, Incision and closure of the abdominal wall is the
most frequent one. Knowledge of the layered structure of the
abdominal wall permits efficient and safe entry into the
peritoneal cavity.

Superficial to deep layers of abdomen:

1. Skin
2. Superficial Fascia
3. Muscles covered by deep
 fascia-abdominal muscle
4. Transversalis
fascia-similar
to endothoracic fascia
5. Parietal Peritoneum
6. Abdominal Cavity
Muscle Origin Insertion Function
Innervation

External Muscular Lateral lip of Anterior Compress

oblique slips from iliac crest; rami of lower abdominal
the outer aponeurosis six thoracic contents; both
surfaces of ending in spinal nerves muscles flex trunk;
the lower midline raphe (T7 to T12) each muscle bends
eight ribs (linea alba) trunk to same side,
(ribs V to turning anterior
XII) part of abdomen to
opposite side

Internal Thoracolum Inferior border Anterior Compress

oblique bar fascia; of the lower rami of lower abdominal
iliac crest three or four six thoracic contents; both
between ribs; spinal nerves muscles flex trunk;
origins of aponeurosis (T7 to T12) each muscle bends
external and ending in linea and L1 trunk and turns
transversus; alba; pubic anterior part of
lateral two- crest and abdomen to same
thirds of pectineal line side
inguinal
ligament

Transversu Thoracolum Aponeurosis Anterior Compress

s bar fascia; ending in linea rami of l abdominal
abdominis medial lip of alba; pubic ower six contents
iliac crest; crest and thoracic
lateral one- pectineal line spinal nerves
third of (T7 to T1 2)
 inguinal and L1
ligament;
costal
cartilages
lower six
ribs (ribs
VII to XII)

Rectus Pubic crest, Costal Anterior Compress

abdominis pubic cartilages of rami of lower abdominal
tubercle, ribs V to VII; seven contents; flex
and pubic xiphoid process thoracic vertebral column;
symphysis spinal nerves tense abdominal
(T7 to T1 2) wall

Pyramidali Front of Into linea alba Anterior Tenses the linea

s pubis and ramus of T1 2 alba
pubic
symphysis

Name Use Picture

2 Used for
Richard retraction of
son (1 wound edges;
small, 1
medium
) or
Right
Angle
Retracto
r
1  Retraction of
Deaver, deep abdominal
extra structures
wide, 3′′

2 Double-ended
Goelet, hand-held
71/2′′ devices that
are used in
general surgical
procedures to
mobilise soft
tissues while
avoiding
damage to their
underlying
structures.

DeLee Features a
universa curved edge to
l, 91/2′′ open the vaginal
walls for
inspection and
access. The
handle is
grooved and
curved to
provide the
surgeon with a
firm grip of the
instrument.
2 Tissue instrument with
Forceps teeth used to
with grasp tissue
teeth, 6′′

2 Adson Adson
forceps forceps are
with equipped with
teeth, fine,
43/4′′ rat tooth tips
that provide a
gentle grasp of
tissues.
These forceps ar
e freqently used
in surgery to
manipulate soft
tissues such as
fascia and skin
during suturing
 Used to grasp dense tissues
1 such as the uterus during
Russian wound closure

Forceps,
7′′

Suture cutting scissors

2
Straight
Mayo
Scissors,
61/4′′
 Cutting and Dissecting,
1 curved, heavy tissue
Curved
Mayo
Scissors,
61/4 “

Longer, thinner scissors

1 used to dissect, undermine
Metzenb delicate tissue. AKA: Metz

aum
Scissors,
7′′

1 Umbilical
Umbilic Scissors are
al non-ratcheted,
Scissors, finger
4′′ ring scissors use
d for cutting
the umbilical
cord. 
1 Lister They are
bandage commonly used 
Scissors, for
31/2 ′′, sizing dressings 
41/2 ′′, and removing
51/2 ′′, circumferential 
bandages. They
71/2 ′′,
may also
8′′
be used to cut
tougher material
such as plaster,
fabric and
occasionally
umbilical cord. 

4 Towel To hold drapes

clips, in place and to
piercing, keep only the
51/2′′ operating field
exposed.
4 Towel
clips,
nonpierc
ing,
51/2′′
12 are surgical
Curved tools used to
Crile control bleeding
Forceps, by clamping and
51/2′′ holding blood
vessels so
4 cauterization or
Straight ligation can be
Crile, performed
51/2′′

Bovie for cauterizing

Electro bleeding tissues.
Cautery Note: fire risk
tip with proximity
of
Chlorhexadine
prep, this is why
prep must dry
for 3 minutes
prior to draping
2 a clamp in a
Babcock special shape for
Forceps, holding
6′′ fallopian tubes

6 Allis Used to perform

Forceps, a “pinch” skin
6′′ test to determine
numbness prior
to start of
surgery, used for
AROM once
bag is seen
through
incision, used to
hold intestinal;
delicate
structures
6 clamps used to
Straight hold fascia (to
Kocher, retract)-note the
61/4′′ tooth and notch
on the tips

6 used to clamp
Pean/M umbilical cord
ayo
Pean
Forceps,
61/4′′
4  to hold gauze
Foerster squares that will
sponge absorb excess
forceps, fluids and blood
7′′ from the
surgical site or
hemostasis.

4 a rarely used
Penning clamp for heavy
ton tissue-
clamp, distinctive
71/2′′ triangle shaped
tips
4 to hold a
Needle suturing needle f
holder, or closing
(2) 7′′ wounds during
and (2) suturing and
8′′ surgical
procedures.

1 Poole used over

(suction incision to
and remove fluid
sheath; when irrigated
2
pieces),
81/4′′
1 To remove
Yankau fluids including
er amniotic fluid,
suction irrigation fluid,
tip, 10′′ blood

3 Knife Used to make

handles, incision in skin,
(2) #3 uterus
and (1)
#4
1 Somer used to extract
uterine tissue, tumors,
elevator, or polyps from
9′′ the uterus by
elevating the
vaginal wall.
The clamps at
the end of the
ring handles
feature serrated
jaws to firmly
grasp the tissue
to be removed.
The clamps are
curved to the
side to optimize
visualization
during
procedures.

1 These
Simpson are used when
obstetric there is
al substantial
delivery molding, that is,
forceps, temporary
12′′ elongation of
the fetal head as
it moves
through
the birth canal.
Barbed  he use of barbed
Suture suture for
uterine incision
closure
at cesarean
section is
associated with
shorter uterine
closure time and
similar early
perioperative
complications
compared with
conventional
smooth suture

Vicryl  Most famous

and kind
Chromic of suture materi
Suture. al which
are used for
uterus suturing i
n cesarean
section are vicry
l and
chromic. Vicryl 
(polyglactin
910) is an
absorbable,
synthetic,
usually
braided suture w
hich is used for
soft tissue
approximation.
The tensile
strength is held
approximately
for 2 - 3 weeks.