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    Ashen Dissanayaka
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    9 views16 pages

    Anterior Ab Wall

    Uploaded by

    Ashen Dissanayaka

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 16
    Anterior abdominal wall CHAPTER 61 The anterior abdominal wall consiues hexagonal ate defined supe tony bythe conta margins and ipod proces Tater by he mi ieis continuous with the posterior abdominal wall and paravertebral tho fom the umbilas and the lngunal cata. which connects the Shlominal cavity to the scrotum fn men ort the labia malora in ‘women, The ametior abdominal wall maintains the ahape of the ‘dysfunction fs equally notable because hernia repair the single most The inegument ofthe anterior abdominal wal compdie sin, soft Steuer, and ymphatc and vascular aructtes, a well a seinen The skin non specialized and variably hist, depending om sex and sce Al poxpberal inva have some extension ofthe pic hit abdominal wall skin though this common {o the umbiasin a wiangular patter. The subeutaneous ft ofthe 2tebmiaal wal highly warble in thichnes depending in part on SOFT TISSUE ‘Superficial fascia The “aerial fc’ of the aomina wal Hes between the dermis an de mules, and econvetioaliy ied into super fy lier (Campers fai) and + deep membranous aye (Sepa sc. In eli there are thc layers ith are layer of adipowe ete deep 10 the membranous ayer (Lanertio eal 201) These dice layer ae paral wel dened inthe hid. Lying within the wiper Adal asl are bloo ves yma. eves ain the Teglon ‘Superficial adipose layer by thar sept Connalng te dems wh te eset ex {nd medal ib otis er naa ne male tise ds and consis very ie Span lng Inthe on abo Lon Sct the sprapi none he some into aia Membranous layer The membranous layer 1 a vadably developed eal composed of ‘ver the anterior abdominal wall, coming thinner fn the upper STabomen (tance el 201), Measured hisologialy is between {and 1 mm thick bt appear thicker on compe’ tomography (i ean (acer ec a BO, Chop 2011 Is lonely cow eved to the undetying external chligue sponeusals and ecus ‘heath by cblique fbvous septa Superior i continuous wth the auerent tthe linea alba and pubie symphysis nfrony, it fases ivi the acces, excends superical ote igulnal ligament and thigh. Inthe male, t extends on tothe dorsum of the penis forming ‘dl fala ofthe perineum (Cole fac) Inthe feral continues the loose areolar eat Benen the membranous ayer of superfci farcaover the nglnal canal and the etemal oblique aponeuton Thi ‘Space fe sometimes called the ape inguinal pouch Deep adipose layer The hcnew ofthe deep adipose layers more vaiabl han the pe thick inthe morbidly bee Is adipootes show diferent meabolic Ssves to those inthe noperia apo layer (Chopra tm 201. Lipomuction preteen tetmaves thi ayer Tat with lave pes ‘ation ofthe sper adipose layer in onde to avok kin Siping Sh otber skin contour neplries (akan aed Baron 1387) Transversalis fas The anmerals faci a hin ayer of connective tue ing between the deep surface of tanserisabdomini and the exaperstonel ft Its pat ofthe general ayer of tinfrciabetween the peiioncum and the talominal wal osteo, st ses eh the anteoe ner ofthe thoracolumbar facia {p.1083) and ante forms continoas hee Superior i Ur wih dhe aca coveting the inferior suace ‘ofthe dtphragm, Infor scontinios with the tac an pelvic patel facia: and fs atached wo the lc crx betwen the ofan ‘he inguinal iment hensen the aneror perio i spine athe femoral sheath Medial ote femoral sheath in and fase co the pubis behind tne conjoint endon, An inferior extension of the tran ‘als asc fons the anor pat ofthe femoral sheath. The fea the deep crural arch), which runs pall tothe inguinal ig {Teoh etal 1999) H Consist of warsvese fibres that fn ou laterally towards the anteor superior fae spine 1 bled with he psoas facia aa an meal bhi the cosolnvendon Yo de pubic owe and laproacopic inguinal hernia tepat. A further thickening ofthe Igual ligament the medial margin ofthe deep inguinal ng tay contain tnsce Eres, ‘ove the cts that pas hough he deep inna ing (the est Ives ands (ducts deferens he mole ae round ligament ‘ofthe enn in the female) Extraperitoneal connective tissue The eraertonesl conn the fae Hing the bd ti tae ping between the peritoneum and inal and peli cae contains vara Sout of fa fe fat epeclly abundant om the pnteroe wal of the abdomen around the Sidney (Paiculaty in obese men) and teanty above the ne cet and tn ch ofthe peli 1069 1070 ANTERIOR ABDOMINAL WALL Septet a ‘ete ay Leora er Fig. 61.41 The bod sippy of he attr soil val VASCULAR SUPPLY AND LYMPHATIC DRAINAGE Undetanding the blood sippy of he asominal wal cal when oeutaneous faps and reconstucing the ‘Tsoi wall sig veral eran feat (eg. ‘Superior epigastric artery and veins The superior epgastic artery ea terminal branch ofthe internal tho- tack ater tary a he ee of est conta extagen dencends between the cox and sipold slips of Ue dapagm, accompanied by two or more vas thet dein o the ional orci vate (re Fig: Fig. 6L.2)- The vessels pass amerir to dhe lower ites of teansersusthotacs and dhe upper fives of tansversiy abomiis| before entering the ret sheath, where they rin infriotyBeind ‘cts abominis They aasomose wh the lltior eigie aei, branching patems (zen ct 2008), Branches supply secu hominis and perforate the anerolamina ‘ofthe ets sheath to supply the abdominal skin. branch given off in the upper seus sheath pases anterior to the tghold procen othe eri and snastomone wth comeing onal Brae This vessel may verge to Bleeding uring Suypcal incisions that ‘tend up to and slongide te xiphod proces, The nuperorepgate urs ant tytn anery ao gives small branche othe anor par ofthe diaphragm. fnasomnne With branche from the hepatic anery Inferior epigastric artery and veins The infor epigastric anery (often refered toa the deep inferior pian arery in clinical prac in order to dso om the ‘perc (iferioeepigasteaey) ongnates om te mei apt 1 ag ae jus protimalto the inguinal games (ee 1g. 61.3), accompanying im, sly two, une fevein that sine int the externa ge en (Rave 3003) curves forwards Inthe aneiorexaperioneal tue and ‘scencis bliquly along he medial margin ofthe deep inguinal ing, ives poueiort the spemmatic cord separned ftom iy the wane by paming anterior tothe arcste hie In thi par of ie couse, ft ‘Wuible through the pascal petioneum of heater abdorainal wall St forms the aera umbiealfl, Disruption of the ary tthe iy surgealincsons (eg, lmseron of laparoscopic ports or abdominal Sain uy welt ins itermaomn tha tan expand ocoaldenble see ‘because of the absence of adlacent tise agains which the bleeding ‘in be amponaded Anterior abdominal wal The vacua supply to the anterior abdominal wall ca be divided supplied by the supeial epigstie, supeidal exe supplied by the miaculophrenks lower intcostal, subconta atd pganic veel from the mii srlevant ositng sug ich ‘at at net Se un ey saith eioten 1070.1 ‘Skin and soft tissue apm gpa at Syed ome ao Pre Somat The inferior epgasc antes ascend and anastomose with thei superior counterpart without ranching. about 30% of cas (EE May and Mer 2002) Beading to eo ese before sa omens the most common patem, accountng for almost OM of “antic ateries have an average dhaeter of proximately my their origin, compared to an average diameter of 6 ni atthe tiga ofthe superior sigaic urea presmably epllning wy the Inferior epiasti anries provide the dominant supply to recs pevormed when preparing myocatarcou Nap ung the mid ower ‘ects abdoinis bated on the aperorepigatie artery, this encour ‘geste agmenttion ofthe superoe epigic arterlsupy Tanches of te infest epigase artery atasomose with branches cot the superior epigatric any within the recs shetth posterior to tects abdomins ata warble lvl abowe the mbes (

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