1. Organization of the antero-lateral abdominal wall
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2. The abdomen
The abdomen is the part of the trunk between the thorax and the pelvis.
Superiorly: Xiphoid process; Costal cartilages of the 7th and 10th ribs.
Inferiorly: Iliac crest; Anterior superior iliac spine;
Inguinal ligament. Pubic tubercle, pubic crest and pubic symphysis.
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5. The abdomen…
The abdomen may be divided into 4 quadrants i.e Right and left upper quadrants
Right and left lower quadrants
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6. The abdomen…
Clinicians refer to nine regions of the abdominal cavity to describe the location of abdominal organs, pains, or pathologies
The nine regions are delineated by four planes:
Two sagittal (vertical), the midclavicular planes that pass from the midpoint of the clavicles (approximately 9 cm from the midline) to the midinguinal points, midpoints of the lines joining the anterior superior iliac spine and the superior edge of the pubic symphysis on each side.
The two transverse (horizontal) planes, Subcostal plane joining the most inferior points of the costal margins, and passing at L3.
Transtubercular plane, joining the tubercles of the iliac crest and the body of the L5 vertebra
The transpyloric plane, extrapolated midway between the superior borders of the manubrium of the sternum and the pubic symphysis (typically the L1 vertebral level)
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7. Nine regions of the abdominal cavity
Inguinal
Inguinal
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9. Abdominal Surgical Incisions
Surgeons use various incisions to gain access to the abdominal cavity. When possible, the incisions follow the cleavage lines (Langer lines) in the skin
Langer lines
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11. Abdominal Surgical Incisions
Longitudinal Incisions
Midline incisions can be made rapidly without cutting muscle, major blood vessels, or nerves. They cut through the fibrous tissue of the linea alba, superior and/or inferior to the umbilicus. Because the linea alba transmits only small vessels and nerves to the skin, a midline incision is relatively bloodless and avoids major nerves
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14. Abdominal Surgical Incisions…
Oblique and Transverse Incisions
Gridiron (muscle-splitting) incisions are often used for an appendectomy. The oblique McBurney incision is made at the McBurney point, approximately 2.5 cm superomedial to the ASIS on the spinoumbilical line. This incision is currently less popular than an almost transverse incision in the line of a skin crease
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15. Abdominal Surgical Incisions…
Transverse incisions
Suprapubic (Pfannenstiel) incisions (bikini incisions) are made at the pubic hairline. These incisions and horizontal with a slight convexity and are used for most gynecological and obstetrical operations (e.g., for cesarean section and removal of a tubal pregnancy).
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16. Abdominal Surgical Incisions
High-Risk Incisions
High-risk incisions include pararectus and inguinal incisions. Pararectus incisions along the lateral border of the rectus sheath are undesirable because they are likely to cut the nerve supply to the rectus abdominis. Blood supply from the inferior epigastric artery also may be compromised.
Inguinal incisions for repairing hernias may injure the ilioinguinal nerve directly or it may be inadvertently included in the suture during closure of the incision. In such cases, people may feel pain in the L1 dermatome region, which includes the scrotum (or the labium majus).
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18. Applied anatomy Incisional Hernia
An incisional hernia is a protrusion of omentum (a fold of peritoneum) or an organ through a surgical incision. Surgeons who make incisions based on a thorough knowledge of anterolateral abdominal wall anatomy will only occasionally have to deal with this problem. However, if the muscular and aponeurotic layers of the abdomen do not heal properly, an incisional hernia can result. Factors predisposing a patient to incisional hernia include advanced age or debility of the patient, obesity, and postoperative wound infection.
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