This document discusses the anatomy of the anterior abdominal wall. It covers the embryology of the abdominal wall muscles and structures like the umbilicus and inguinal region. It then discusses the layers of the anterior abdominal wall, muscles, fascia, blood supply, lymphatics and nerve supply. It also covers hernias that can occur in the abdominal wall and types of abdominal incisions.

1. DR. REMMIES RAPHEL
FIRST YEAR PG
GENERAL SURGERY

2. contents
01
02 ANATOMY
03 BLOOD SUPPLY AND LYMPHATIC
DRAINAGE
04 NERVE SUPPLY
05 TYPES OF HERNIA AND
ABDOMINAL INCISIONS
EMBRYOLOGY

3. 01
EMBRYOLOGY
 ANTERIOR ABDOMINAL WALL
 UMBLICUS
 INGUINAL REGIION

4. By the end of the 5th week,
somites derived from the
paraaxial mesoderm
differentiate into two groups
of prospective muscle cells-
HYPOMERES AND EPIMERES.
The hypomeres in the abdominal
region splits to give rise to
the external oblique ,
internal oblique and
transversus abdominis muscle.
01 EMBRYOLOGY
ANTERIOR ABDOMINAL WALL

5. UMBLICUS
Umblicus is a midline fusion of the medial aponeurotic borders of both rectus abdominis
aponeurosis around the umblical cord at the 10th week, after the herniated midgut returns to
the peritoneal cavity.

6. Umblical Region Contains
 Skin
 fibrous layer - (fusion of UR,MUL,RL)
Vestiges of the allantois ( urachus - median umblical ligament )
Umblical arteries ( 2 medial umblical ligaments )
Umblical vein ( ligament teres )
 Tranversalis fascia
 Umblical fascia
 peritoneum

7. INGUINAL REGION
Before the descent of the testis and the ovary from their
site of origin high on the posterior abdominal wall, a
peritoneal diverticulum called the processus vaginalis is
formed. The processus vaginalis passes through the layers
of the lower part of the anterior abdominal wall and form
inguinal canal.

8. 02
Anatomy
 Anterior Abdominal Wall
 Umblicus
 Inguinal region

9. ANTERIOR ABDOMINAL WALL

10. ANTERIOR ABDOMINAL WALL
There are nine layers to the abdominal wall:
1.skin
2.subcutaneous tissue
3. superficial fascia
4.external oblique muscle
5.internal oblique muscle
6.transversus abdominis muscle
7.transversalis fascia
8.preperitoneal adipose tissue
9.peritoneum.

11. 02 Superficial fascia
The superficial fascia is divided into a superficial fatty layer (fascia of Camper) and a deep
membranous layer (Scarpa’s fascia).
 Camper’s fascia modified as
dartos muscle in scrotum.

12. Scarpa’s fascia
 Rupture of the penile urethra
followed by extravasation of
urine excluded from the thigh.
 An ectopic testis in the groin
cannot descend any lower into
the thigh.

13. DEEP FASCIA
The deep fascia in the anterior abdominal wall is merely a thin layer of connective tissue covering the muscles; it lies
immediately deep to the membranous layer of superficial fascia.

14. Anterior abdominal wall
muscles
5 muscles ; 3 thin flat sheaths and 2 vertical muscles

15. EXTERNAL OBLIQUE MUSCLE
ORGIN: Muscular slips from the outer surfaces of
the lower eight ribs (5th to 12th rib )
The fibres run downwards, forwards and medially.
INSERTION: Lateral lip of iliac crest; aponeurosis
ending in midline raphe (linea alba )
Innervation: Anterior rami of lower six thoracic
spinal nerves (T7 to T12)

16. INTERNAL OBLIQUE
ORGIN: The lateral two-thirds of the inguinal ligament,The anterior
two-thirds of the intermediate area of the iliac crest, and The
thoracolumbar fascia.
Fibres run upwards, forwards and medially crossing the fibres of
the external oblique
muscle at right angles.
INSERTION: Inferior border of the lower three or four ribs ;
aponeurosis ending in linea alba,pubic crest and pectineal line.
INNERVATION: Anterior rami of lower six thoracic spinal nerves
and first lumbar nerve (T7-T12,L1)

17. TRANSVERSUS ABDOMINIS
ORGIN: The lateral one-third of the inguinal ligament, The
anterior two-thirds of the inner lip of the iliac crest,The
thoracolumbar fascia,The inner surfaces of the lower six
costal cartilages (7th to 12th ribs)
The fibres are directed horizontally forwards.
INSERTION: Aponeurosis ending in linea alba,pubic crest and
pectineal line.
INNERVATION: Anterior rami of lower six thoracic spinal
nerves and first lumbar nerve (T7-T12,L1).

18. RECTUS ABDOMINIS
ORGIN: Lateral head from the lateral part of the
pubic crest,Medial head from the medial part of
pubic crest and anterior pubic ligament.
The fibres run vertically upwards
INSERTION: Costal cartilages of ribs 5th to 7th,
xiphoid process.
INNERVATION: Anterior rami of Lower six or
seven thoracic spinal nerves.

19. PYRAMIDALIS

20. FASCIA TRANSVERSALIS
Thin layer of fascia between transversus abdominis and extraperitoneal fat.
Anteriorly: It is adherent to the linea alba above the umbilicus.
Posteriorly: It merges with the anterior layer of the thoracolumbar fascia and is continuous with the renal fascia.
Superiorly: It is continuous with the diaphragmatic fascia.
Inferiorly: It is attached to the inner lip of the iliac crest and to the lateral half of the inguinal ligament. At both these places,
it is continuous with the fascia iliaca.
Medially, it is attached to the pubic tubercle, the pubic crest and the pectineal line. Part of it is prolonged into the thigh as
the anterior wall of the femoral sheath.

21. PERITONEUM
 The peritoneum lining the walls is parietal peritoneum.
 The peritoneum covering the viscera is visceral peritoneum.
The extraperitoneal fat is a thin layer of connective tissue that contains a variable amount of fat and lies between the fascia transversalis and
the parietal peritoneum.

22. RECTUS SHEATH
Rectus sheath is an aponeurotic sheath covering the rectus abdominis. It has two walls—anterior and posterior.
(a) Above the costal margin, (b) between costal margin and arcuate line, and (c) below arcuate line,
Contents
Muscles
1 The rectus abdominis.
2 The pyramidalis (if present).
Arteries
1 The superior epigastric artery enters the sheath by
passing between the costal and xiphoid origins of
the diaphragm.It supplies the rectus abdominis muscle
and anastomoses with the inferior epigastric artery.
2 The inferior epigastric artery enters the sheath by
passing in front of the arcuate line.
Veins
1 The superior epigastric venae and join the internal
thoracic vein.
2 The inferior epigastric venae and join the external iliac
vein.
Nerves :Lower six thoracicnerves.

23. INGUINAL REGION
The inguinal region of the body, also known as the groin, is located
on the lower portion of the anterior abdominal wall, with the thigh
inferiorly,
the pubic tubercle medially, and
the anterior superior iliac spine (ASIS) superolaterally.
The inguinal canal is a tubular structure that runs inferomedially
and contains the spermatic cord in males and the round ligament in
females.

24. BOUNDARIES OF INGUINAL CANAL

25. 03
BLOOD SUPPLY AND LYMPHATICS
 ARTERIAL SUPPLY
 VENOUS DRAINAGE
 LYMPHATIC DRAINAGE

26. 03 ARTERIAL SUPPLY
 The skin near the midline is supplied by branches
of the superior and inferior epigastric arteries.
 The skin of the flanks is supplied by branches of
the intercostal, lumbar, and deep circumflex iliac
arteries.
 In addition, the skin in the inguinal region is
supplied by the superficial epigastric, the
superficial circumflex iliac, and the superficial
external pudendal arteries, branches of the
femoral artery.

27. 03 VENOUS DRAINAGE
The venous drainage passes above mainly into the axillary
vein via the lateral thoracic vein and below into the femoral
vein via the superficial epigastric and the great saphenous
veins.

28. 03 LYMPHATICS
Superficial lymphatics above umblicus pass in a superior
direction to the axilary nodes.
Below the umblicus passes in an inferior direction to the
superficial inguinal nodes.

29. 04
NERVE SUPPLY

30. 04 NERVE SUPPLY
The skin and muscles of the anterolateral
abdominal wall are supplied by T7 -T12
and L1 spinal nerves

31. 05
CLINICAL SIGNIFICANCE
 HERNIA
 ABDOMINAL INCISIONS

32. 05 TYPES OF HERNIA
 Umblical -
paraumblical hernia
 Epigastric Hernia
 Incisional Hernia
 Spigelian Hernia
 Inguinal Hernia
 Femoral hernia

33. 05 ABDOMINAL INCISIONS

34.  LAST ANATOMY
 SNELL ‘S CLINICAL ANATOMY
 BD CHAURASIA
REFERENCE

35. THANK YOU!