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1. 2. 3. 4. skin superficial fascia a. Camper’s – BV and nerves b. Scarpa’s deep fascia muscles PYRAMIDALIS MUSCLE -innervated by T12 DERMATOME -area of the skin supplied by a single nerve ex: umbilicus: T10
NEUROVASCULAR SUPPLY INNERVATION: -7th-12th intercostal nerves and 1 lumbar nerve -travel in b/n muscular layers (transversus abdominis and internal oblique) -will eventually end up at the anterior rectus sheath -below the peritoneum -anterior rami of intercostal nerves proceed anteriorly -posterior rami of intercostal nerves proceed posteriorly ANTERIOR RAMI OF INTERCOSTAL NERVES: *lateral cutaneous branch – branching near the midaxillary line; as it proceeds anteriorly it penetrates the posterior rectus sheath, near the lateral border of rectus abdominis; supplies rectus abdominis; gives out medial and lateral cutaneous branches LUMBAR NERVE 1 -2 branches: 1. ilioinguinal 2. iliohypogastric -supplies lateral abdominal wall (oblique muscles and rectus abdominis) -does not penetrate posterior rectus sheath (because there is no post. rectus sheath at this level) -goes to cutaneous area, one travels w/ the spermatic cord, one pierces the ext oblique aponeurosis
*lateral part of abdominal wall – lateral cutaneous branches of posterior intercostal nerves are accompanied by cutaneous vessels arising from the posterior intercostals arteries *near midline of abdominal wall – cutaneous branches of intercostal nerves are accompanied by branches of the superior and inferior epigastric vessels ARTERIAL SUPPLY OF ABDOMINAL WALL: 1. internal thoracic/mammary superior epigastric supplies midline 2. thoracic aorta last 2 intercostal arteries 3. abdominal aorta 4 lumbar arteries (follow same course of intercostal arteries) 4. external iliac a. deep circumflex iliac (from external iliac behind inguinal ligament supplies lower part of abdominal wall) b. deep inferior epigastric – supplies the midline of abdominal wall; medial to deep inguinal ring transversalis fascia posterior rectus sheath (above arcuate line) anastomosis with superior epigastric artery 5. femoral artery a. superficial epigastric – same course as inferior epigastric; confined w/in Camper’s fascia umbilicus; supplies cutaneous surface of anterior abdominal wall
supraumbilical veins -veins draining from above the umbilicus will drain into the axillary vein via the lateral thoracic vein 2. proceeds parallel to inguinal ligament.ABDOMEN – NEUROVASCULAR SUPPLY November 15. at proximal femur) VENOUS DRAINAGE OF ABDOMINAL WALL: -2 groups: 1. infraumbilical veins -veins draining from below the umbilicus will drain into the femoral vein via the superficial epigastric vein Thoracoepigastric vein – anastomosis of superior and inferior veins in relation to the umbilicus DEEP VEINS -correspond to arterial supply -superior epigastric vein internal mammary vein -inferior epigastric vein external iliac vein -lumbar veins inferior vena cava -2 intercostal veins azygos vein (on the right) and hemiazygos vein (on the left) superior vena cava . 2011 2 b. superficial circumflex iliac – same course as deep circumflex iliac but confined within Camper’s fascia. c. supplies groin/inguinal area superficial external pudendal Para-umbilical veins -anastomose the systemic veins with the portal venous system -when engorged due to portal HPN “caput medusa” LYMPHATICS: -also divided into groups above and below umbilicus -above: axillary lymph nodes -below: superficial inguinal nodes GROIN FLAP -may be used (harvested) to cover a defect of the dorsal area of the hand -supplied by superficial circumflex iliac artery RECTUS ABDOMINIS MUSCLE -supplied by superior epigastric and inferior epigastric arteries -possible source of “muscle flap” (esp.