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Anatomy of Anterior Abdominal Wall

Anatomy of Anterior Abdominal Wall. Mohammed El-Matary Lecturer of General Surgery Ain Shams University. Anterior Abdominal Wall. Layer of anterior abdominal wall: A- Lateral: 1- Skin. 2- Subcutaneous tissue. 3- External oblique muscle.

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Anatomy of Anterior Abdominal Wall

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  1. Anatomyof 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. A- Lateral 5- Transversus abdominis m.

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

  17. B- Medial 4- Rectus Muscle

  18. 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 1- Lower 6 intercostal cartilages Origin 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 Origin 7th, 6th, 5th costal cartilages Xiphoid process From the pubic crest

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

  36. 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 Linea Alba Medially Arcuate Line Linea Semilunaris Laterally

  40. Rectus Sheath Above Arcuate Line 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 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. - I -Internal Mammary a. - II - Descending Aorta 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

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