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  • Presenter: Dr. A. R. Shaan Moderator: Dr. S. B. Choudhary

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    Adesh Jawale
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    The document summarizes the anatomy of the anterior abdominal wall, including its layers, muscles, fascia, ligaments, vasculature and innervation. It discusses common incisions used in abdominal surgery like midline, transverse and oblique incisions. It also covers complications of incisions like nerve injury, dehiscence and hernias. Specifically, it describes types of umbilical and ventral hernias as well as rare hernias like Spigelian hernia.

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    The document summarizes the anatomy of the anterior abdominal wall, including its layers, muscles, fascia, ligaments, vasculature and innervation. It discusses common incisions used in abdominal surgery like midline, transverse and oblique incisions. It also covers complications of incisions like nerve injury, dehiscence and hernias. Specifically, it describes types of umbilical and ventral hernias as well as rare hernias like Spigelian hernia.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    12 views56 pages

    Presenter: Dr. A. R. Shaan Moderator: Dr. S. B. Choudhary

    Uploaded by

    Adesh Jawale
    The document summarizes the anatomy of the anterior abdominal wall, including its layers, muscles, fascia, ligaments, vasculature and innervation. It discusses common incisions used in abdominal surgery like midline, transverse and oblique incisions. It also covers complications of incisions like nerve injury, dehiscence and hernias. Specifically, it describes types of umbilical and ventral hernias as well as rare hernias like Spigelian hernia.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 56

    Presenter: Dr. A. R.

    Shaan
    Moderator: Dr. S. B. Choudhary
    Surface Topography
    Layers of Anterior Abdominal Wall
    Superficial Fascia
    Superficial Fascia
    Fundiform ligament of penis
    Anterolateral Muscles
    • 5 Muscles

    o 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 wall


    Upper 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 Only anterior layer of sheath present
    present

    Aponeurosis of external oblique weak or Aponeurosis of external oblique strong


    absent 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”.

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