anatomy of anterior abdominal wall

1. Presenter: Dr. A. R. Shaan
Moderator: Dr. S. B. Choudhary

2. Surface Topography

3. Layers of Anterior Abdominal Wall

4. Superficial Fascia

5. Superficial Fascia

6. Fundiform ligament of penis

7. Anterolateral Muscles
• 5 Muscles
o 3 flat muscles
• External Oblique
• Internal Oblique
• Transersus abdominis
o 2 vertical muscles
• Rectus abdominis
• Pyramidalis

8. External Oblique Muscle and Aponeurosis

9. External Oblique Aponeurosis
“Touch Down Point”

10. Ligaments from Ext. Oblique Aponeurosis
Medial Crus
Lateral Crus

11. Cooper’s Ligament (pectineal ligament)

12. Internal Oblique

13. Transversus Abdominis

14. Rectus Abdominis & Pyramidalis

15. Rectus Sheath

16. Rectus Muscle and Sheath

17. Linea Alba

18. Umbilical Region

19. Umbilical Ring

20. Variations in Umbilical ring

21. Extraperitoneal Fascia

22. Extraperitoneal Fascia

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. Blood supply
• Superficial
• Deep

25. Superficial Arteries

26. Deep Arteries

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. Vascular territories

29. Lymphatics

30. Innervation

31. Dermatomes

32. Incisions on Abdominal Wall
• “ Pray before surgery, but remember: God
will not alter a faulty incision”
• Keeney’s Dictum

33. Maingot’s 3 requirements:
• Accesibility
• Extensibility
• Security

34. Varieties of Abdominal incisions

35. Midline Incisions

36. Extended Midline Incision

37. Paramedian Incision

38. Pararectus Incision (Kammerer-Battle)

39. Midrectus (transrectus )Incisions

40. Transverse Incisions
• Upper Abdominal transverse incisions
• Lower abdominal transverse incisions
• Rockey davis incisions
• Pfannelstiel incisions

41. Pfannelstiel Incision

42. Extended Transverse incisions

43. Oblique incisions
• Subcostal incisions and extensions
• Mc Burney incisions and extensions

44. Complications follwing incisions
• Nerve injury
• Dehiscence
• Incisional hernia

45. Epigastric (Ventral) Hernia

46. Umbilical hernia
• Congenital
• Upper
• Middle
• Lower
• Aquired

47. Congenital umbilical hernia

48. Umbilicus Layers

49. Umbilical Herniation

50. Aquired Umbilical Hernia

51. Omphalocele ( Exomphalos)

52. Gastroschisis

53. Spigelian Hernia

54. Spigelian hernia Relations

55. Spigelian Hernia Layers

56. From every wound
there is a scar, and
every scar tells a story.
A story that says
“ I have survived”.