1. Anatomy of Anterior Abdominal Wall
Mohammed El-Matary
Lecturer of General Surgery
Ain Shams University

2. Anterior Abdominal Wall
Layer of anterior abdominal wall:
A- Lateral:
1- Skin.
2- Subcutaneous tissue.
3- External oblique muscle.
4- Internal oblique muscle.
5- Transversus abdominis muscle.
6- Fascia transversalis.
7- Peritoneum.

3. Anterior Abdominal Wall
B- Medial:
1- Skin.
2- Superficial fascia.
3- Anterior wall of rectus sheath.
4- Rectus muscle.
5- Posterior wall of rectus sheath.
6- Peritoneum.

4. A- Lateral Side

5. A- Lateral
1- Skin

6. A- Lateral
2- Subcutaneous tissue

7. A- Lateral
3- External Oblique m.

8. A- Lateral
4- Internal Oblique m.

9. 5- Transversus abdominis m.
A- Lateral
5- Transversus abdominis m.

10. 6- Fascia Transversalis m
A- Lateral
6- Fascia Transversalis m

11. A- Lateral
7- Peritoneum

12. B- Medial Side

13. Anterior Abdominal Wall
Layer of anterior abdominal wall:
B- Medial:
1- Skin.
2- Superficial fascia.
3- Anterior wall of rectus sheath.
4- Rectus muscle.
5- Posterior wall of rectus sheath.
6- Peritoneum.

14. B- Medial
1- Skin

15. B- Medial
2- Subcutaneous tissue

16. 3- Ant. Wall of Rectus sheath
B- Medial
3- Ant. Wall of Rectus sheath

17. B- Medial
4- Rectus Muscle

18. 5- Post. Wall of Rectus sheath
B- Medial
5- Post. Wall of Rectus sheath

19. B- Medial
6- Peritoneum

20. External Oblique
Muscle

21. External Oblique Muscle
Origin
Fleshy digitations from the lower 8 ribs

22. External Oblique Muscle
Xiphoid
Process
Insertion
The muscle is inserted by fleshy fibers as well as aponeurosis, as follows:
A- Fleshy fibers:
Outer lip of the iliac crest
B- Aponeurosis:
Medial part → linea alba from xiphoid process to symphysis pubis
Lateral part → folded upwards & backwards upon itself to form the inguinal ligament (ASIS → pubic tubercle)
Symphysis Pubis

23. External Oblique Muscle
Direction of fibers
Downward
Forwards
Medially

24. External Oblique Muscle
Nerve Supply
Intercostal nerves (T7 -T11) &
Subcostal nerve (T12)

25. Internal Oblique
Muscle

26. Internal Oblique Muscle
Origin
Anterior 2/3 of the intermediate line of the iliac crest
The lateral 2/3 of the inguinal ligament
Lumbar fascia
Insertion
Lower 6 costal cartilages
Xiphoid process
Linea Alba
Pubic crest

27. Internal Oblique Muscle
Direction of fibers
Upwards
Forwards
Medially
Nerve Supply
T7-T12
Iliohypogastric n.
Ilioinguinal n.

28. Transversus Abdominis
Muscle

29. Transversus Abdominis Muscle
Origin
1- Lower 6 intercostal cartilages
4- Lat. 1/3 of inguinal ligament
2- Lumbar Fascia
3- Ant. 2/3 of inner lip of iliac crest

30. Transversus Abdominis Muscle
Insertion
1- Xiphoid Process
3- Linea Alba
2- Pubic Crest

31. Transversus Abdominis Muscle
Direction of fibers
Horizontally

32. Transversus Abdominis Muscle
Nerve Supply
T7-T12
Iliohypogastric n.
Ilioinguinal n.

33. Rectus Abdominis
Muscle

34. Rectus Abdominis Muscle
Insertion
7th, 6th, 5th costal cartilages
Xiphoid process
Origin
From the pubic crest

35. Rectus Abdominis Muscle
The muscle is divided into segments by tendinous intersections, Which indicate that the muscle arises from a number of myotomes, fused together
Surgical Importance
1- Segmental nerve supply.
2- Hematoma of rectus m. is localized
2- In paramedian incision  displace m.
laterally (n. supply comes from lateral)

36. It is a landmark of linea alba intraoperative
Pyramidalis Muscle
It is a landmark of linea alba intraoperative

37. Actions of Anterior Abdominal Wall Muscles
They assist in raising the intra-bdominal pressure (so, they help in vomiting, cough, delivery, etc….)
Keep the abdominal viscera in position.
Rectus abdominis flexes the trunk, while the 2 oblique muscles bend the trunk laterally.
Act as accessory expiratory muscles.
Lower midline & paramedian incisions.

38. Rectus Sheath

39. Rectus Sheath Medially Laterally Linea Alba Arcuate Line
Linea Semilunaris
Laterally

40. Rectus Sheath Above Arcuate Line SKIN Peritoneum External Oblique
Ant. Layer of Rectus Sheath
Internal Oblique
Transversus Abdominis
Rectus Abdominis
SKIN
Falciform Ligament
Peritoneum
Transverslais Fascia
Post. Layer of Rectus Sheath

41. Rectus Sheath Below Arcuate Line SKIN Peritoneum External Oblique
Ant. Layer of Rectus Sheath
Internal Oblique
Transversus Abdominis
Rectus Abdominis
SKIN
Transverslais Fascia
Peritoneum
Urachus in Median Umbilical Fold
Medial Umbilical Ligament

42. Arterial Supply
of Anterior
Abdominal Wall

43. Deep circumflex iliac a.
- II - Descending Aorta
- I - Internal Mammary a.
Superior epigastric a.
10th, 11th intercostal a.
Subcostal a.
- III - External Iliac a.
Deep circumflex iliac a.
Inferior epigastric a.

44. Thanks You
Mohamed Noman