Dissecting Instruction

Anterior Abdominal wall and

Inguinal Region

Akkradate Siriphorn
Akkradate@msn.com
Jan 9th, 2007

Skin Incisions

1
 Skin Incisions

Skin Incisions

Labia majora

Ant. labial
commissure

Post. labial
commissure

2
Incision of Superficial fascia

Î
Î

5 cm
Î
Î

Superficial Vessles

Superficial
Epigastric
artery

Superficial
Cercumflex
Iliac artery

3
 Cutaneous Nerve
T7
Find
T7
T8
• Anterior cutaneous branch
T8
™ Intercostal nerve (T7-T11)
T9
T9 ™ Subcostal nerve (T12)
T10 T10 ™ iliohypogastric nerve (L1)
T11
T11
T12
T12 L1
• Lateral cutaneous branch
L1 • Each nerve divided into small
posterior and large anterior
branch.

Remove
• all remains of superficial fascia.

Fascia
• Cut : Fundiform ligament • Cut : suspensory ligament

4
Identify & Study
• M. External abd. oblique
• Superficial inguinal ring
™ Laterlar (inferior) crus
™ Medial (superior) crus
™ Intercrural fibers

Study

Spermatic Cord

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 Dissecting Instruction
Lateral crus
(ASIS) • Attach to the pubic
tubercle via the
inguinal ligament.

Medial crus
• Attach to the pubic
bone and crest

Intercrural fiber
• Between two crus.

Identify
- Linea alba
- Pubic crest
M.Serratus anterior
- Pubic tubercle
- Inguinal ligament
(ASIS Æ Pubic Tubercle)
M. Ext.abd. obl.

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 Ligament

Lacunar ligament: backward to pecten pubis (Pectineal line)

Pectineal ligament: lateral part of lacunar ligament

Reflected part of inguinal ligament

Inguinal lig.
(Poupart’s lig.)
Conjointed tendon
Pectineal lig.
Cremaster m. (Cooper’s lig.)
Lacunar lig.
(Gimbernat’s lig. )
Suspensory lig.
of penis

Reflected inguinal lig.

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 Lacunar ligament

Dissecting Instruction
Inguinal contents
• Spermatic cord
¾ traverses the superficial
inguinal ring.
• Ilioinguinal nerve
¾ emerges from the ring lateral to
the spermatic cord.
¾ this nerve sends sensory twigs
to the external gennitalia and
medial aspect of the thigh.

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 External oblique Incision
Cut
Aponeurosis of external oblique
¾ ASIS Æ linea semilunalis
¾ Margin Æ apex of superficial
inguinal ring

¾Insert two fingers into the

incision, separate the fibers of
the external oblique from the
fascia of the underlying internal
oblique.

External oblique Incision

Remove:
External abdominal Olique from
• Interdigitation of M.serratus ant.
• M. Latissimus dorsi
• Iliac crest Æ ASIS

Reflect the divided external

Lumbar oblique:
• Proceed as follows:
Post. Layer of ¾ Inferior part: reflect inferiorly
thoracolumbar fascia ¾ Superior part: reflect medially
until stopped by rectus sheath.

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Identify & Study
• M. Internal abd. oblique
• Cremasteric muscle & fascia
• Conjoint tendon

Rectus Sheath
3/4
1/4

10
 Internal oblique Incision
Cut
internal abdominal oblique
and cremasteric muscle

Internal oblique Incision

Remove:
M.Transversus
abdominis Internal Abdominal Olique
Rectus sheath from
- ant. • lower 3 ribs
- post.
• thoracolumbar fascia
• iliac crest
L1
• ASIS over the inguinal canal
I-H
and spermatic cord
I-I I M.Int. abd.
obl.
Reflect internal abdominal
M.Int. abd. obl. oblique medially.

11
 Study Lower Intercostal Nerve

Deep circumflex iliac artery

Deep circumflex iliac a.

M.Transversus abdominis

Deep circumflex iliac a.

Sup. circumflex iliac a. branch of Ext. iliac art.

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 Identify & Study
M. Transversus Abdominis
Insertion : aponeurosis
Upper 3/4
: post. layer of Rectus sheath
Lower ¼
: ant. layer of Rectus sheath

Transversus Abd. Incision

Remove:
M.Transversus
abdominis Internal Abdominal Olique
Rectus sheath from
- ant. • costal margin
- post.
• thoracolumbar fascia
• iliac crest
L1

Reflect internal abdominal

I-I
I-H I M.Int. abd. oblique medially.
obl.

M.Int. abd. obl.

Do not disturb and Keep
nerve laterally.

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 Transversalis Fascia

M. Anterolateral Abdominal

M. Ext.abd.obl. M. Int.abd.obl. M. Transv.abd.

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Female Structure

Female Structure

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 Rectus Sheath Incision
Study:
Rectus sheath & it’s contents

Cut:
Vertical incision anterior rectus
sheath:
From Pubic crest Æ 5th costal
cartilage
™ Inferior to umbrilicus: ½ inch
from midline
™ Superior to umbrilicus: 1 inch
from midline

Rectus Abdominis
Detachment:
Tendinous intersection of
rectus abd. from rectus sheath

Study:
M. Rectus abdominis
M. Pyramidalis
Sup. & Inf. epigastric vessles
Posterior rectus sheath
Arcuate Line
Linea Alba

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 Rectus Abdominis Incision
Cut:
In its middle, divide the
M.Rectus abd. transversely.
Carfully reflect the two halves
superiorly and inferiorly,
respectively.

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