Applied Anatomy

A) Incisions in the anterior abdominal wall
Midline

Because the vessels mainly approach the linear alba from the sides, the linear alba is a water shed area. Besides

the composition of connective tissue (fibro elastic) with a low metabolic turn-over, does not necessitate very profuse

vascularization. Consequently, incisions here do not cause troublesome bleeding. However, union is slow, and therefore

either non-absorbable or long staying suture material is required when closing up. Otherwise deficits will remain, and be

potential sites for hernia (incisional hernia).

  
Paramedian

Usually, the rectus abdominis is retracted laterally, to avoid detaching its nerve and vessels. It is unwise to cut the muscle longitudinally.

These incisions, do not meet many blood vessels. The epigastric vessels (inferior and superior) are usually easy to identify.

  
Horizontal incision

Especially in the lower abdomen (Pfanesteil) may encounter the inferior and superficial epigastric vessels. If these can be guarded, handled, the incision heals rapidly, leaving thin scars.

  
Gridiron incision  

It is mentioned under appendix

  

B) Hernias
 

A hernia is an abnormal protrusion of structures from one anatomical region to another (internal) or from the body cavity to the exterior (external).

 

Internal Herniae External Herniae

  • Hiatus hernia
  • Other diaphragmatic herniae
  • Herniae into the peritoneal recesses e.g. Para-duodenal, retro-caecal, through epiploic foramen
  • Epigastric
  • Umbilical
  • Inguinal
  • Femoral
Inguinal Hernias  
Direct Indirect

  • Less common type
  • more likely in older men (over 40).
  • Protrudes anteriorly through the posterior wall of inguinal canal
  • Medial to inferior epigastric artery.
  • passes through inferior part of inguinal triangle.
  • Does not pass through the deep inguinal ring, but pass through superficial ring.
  • Usually results from weakening of the Conjoint tendon
  • More common type,makes 75% of all.
  • more common in male children,
  • Takes the path taken by testis through inguinal canal
  • Leaves lateral to inferior epigastric artery.
  • Passes outside inguinal triangle.
  • Passes through the deep inguinal ring and superficial ring to enter the scrotum
  • More likely in patent processus vaginalis

 

  

Venous engorgement in anterior abdominal wall

 

Caput medusae:

  • Distended veins radiating from the umbilicus
  • Suggest portal hypertension.
  • They arise because para umbilical veins communicate with the portal veins through potential veins in the ligamentum teres.

Enlargement of the veins on the sides may suggest obstruction of one of the vena cavae.

 


Anterior Abdominal Wall and the Peritoneum