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Surgical Anatomy of anterior abdominal wall

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anatomy of anterior abdominal wall

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Surgical Anatomy of anterior abdominal wall

  1. 1. Presenter: Dr. A. R. Shaan Moderator: Dr. S. B. Choudhary
  2. 2. Surface Topography
  3. 3. Layers of Anterior Abdominal Wall
  4. 4. Superficial Fascia
  5. 5. Superficial Fascia
  6. 6. Fundiform ligament of penis
  7. 7. Anterolateral Muscles • 5 Muscles o 3 flat muscles • External Oblique • Internal Oblique • Transersus abdominis o 2 vertical muscles • Rectus abdominis • Pyramidalis
  8. 8. External Oblique Muscle and Aponeurosis
  9. 9. External Oblique Aponeurosis “Touch Down Point”
  10. 10. Ligaments from Ext. Oblique Aponeurosis Medial Crus Lateral Crus
  11. 11. Cooper’s Ligament (pectineal ligament)
  12. 12. Internal Oblique
  13. 13. Transversus Abdominis
  14. 14. Rectus Abdominis & Pyramidalis
  15. 15. Rectus Sheath
  16. 16. Rectus Muscle and Sheath
  17. 17. Linea Alba
  18. 18. Umbilical Region
  19. 19. Umbilical Ring
  20. 20. Variations in Umbilical ring
  21. 21. Extraperitoneal Fascia
  22. 22. Extraperitoneal Fascia
  23. 23. Comparison of upper and lower three-fourths of anterior abdominal wall Upper Midline Lower Midline Linea alba well developed Linea alba poorly developed Right and left recti well separated Right and left recti close together Anterior and posterior layers of sheath present Only anterior layer of sheath present Aponeurosis of external oblique weak or absent Aponeurosis of external oblique strong and well developed
  24. 24. Blood supply • Superficial • Deep
  25. 25. Superficial Arteries
  26. 26. Deep Arteries
  27. 27. Vessels of anterior abdominal wall EOP- Ext Oblique Perforators SCI- Superficial Circumflex Iliac SE- Superior Epigastric DCI- Deep Circumflex Iliac IE- Deep , inferior Epigastric Artery SIEA- Superficial inferior Epigastric artery
  28. 28. Vascular territories
  29. 29. Lymphatics
  30. 30. Innervation
  31. 31. Dermatomes
  32. 32. Incisions on Abdominal Wall • “ Pray before surgery, but remember: God will not alter a faulty incision” • Keeney’s Dictum
  33. 33. Maingot’s 3 requirements: • Accesibility • Extensibility • Security
  34. 34. Varieties of Abdominal incisions
  35. 35. Midline Incisions
  36. 36. Extended Midline Incision
  37. 37. Paramedian Incision
  38. 38. Pararectus Incision (Kammerer-Battle)
  39. 39. Midrectus (transrectus )Incisions
  40. 40. Transverse Incisions • Upper Abdominal transverse incisions • Lower abdominal transverse incisions • Rockey davis incisions • Pfannelstiel incisions
  41. 41. Pfannelstiel Incision
  42. 42. Extended Transverse incisions
  43. 43. Oblique incisions • Subcostal incisions and extensions • Mc Burney incisions and extensions
  44. 44. Complications follwing incisions • Nerve injury • Dehiscence • Incisional hernia
  45. 45. Epigastric (Ventral) Hernia
  46. 46. Umbilical hernia • Congenital • Upper • Middle • Lower • Aquired
  47. 47. Congenital umbilical hernia
  48. 48. Umbilicus Layers
  49. 49. Umbilical Herniation
  50. 50. Aquired Umbilical Hernia
  51. 51. Omphalocele ( Exomphalos)
  52. 52. Gastroschisis
  53. 53. Spigelian Hernia
  54. 54. Spigelian hernia Relations
  55. 55. Spigelian Hernia Layers
  56. 56. From every wound there is a scar, and every scar tells a story. A story that says “ I have survived”.

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