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Abdominal Wall
Embryological development
Anatomical features of anterior abdominal
wall
Relationship between structure and
function
Clinical and surgical relevance
Disease
Congenital or acquired
incisions
Embryology of the anterior
abdominal wall
During the 4th to 5th week of
development, the flat embryonic disk
folds in four directions and/or
planes:
Cephalic
Caudal
Right lateral
left lateral
1. Amniotic cavity
2. Ectoderm
3. Umbilical vesicle
4. Endoderm
5. Body stalk
6. Allantois
7. Extraembryonic mesoderm
8. Cloacal membrane
9. Notochordal process
14. notochord
20. Fused neural tube
Septum transversum
29. Aortas
30. Umbilical veins
36. Somite
2. Ectoderm
3. Umbilical vesicle
4. Endoderm
5. Body stalk
6. Allantois
7. Extraembryonic mesoderm
8. Cloacal membrane
9. Notochordal process
14. notochord
20. Fused neural tube
Septum transversum
29. Aortas
30. Umbilical veins
36. Somite
2. Ectoderm
3. Umbilical vesicle
4. Endoderm
5. Body stalk
6. Allantois
7. Extraembryonic mesoderm
8. Cloacal membrane
9. Notochordal process
14. notochord
20. Fused neural tube
Septum transversum
29. Aortas
30. Umbilical veins
36. Somite
Gastroschisis:
Full thickness abdominal wall defect
situated almost always to the right of the umbilicus
without a covering membrane.
A bridge of skin separates it from the umbilicus.
Insertion:
Linea alba with aponeurosis of internal oblique
pubic crest, and pecten pubis via conjoint tendon
Transverse abdominal
the innermost of the three
flat abdominal muscles
Fibres run more or less
transversally except for the
inferior ones, which run
parallel to those of the
internal oblique.
The fibers of the transverse
abdominal muscle also end
in an aponeurosis which
contributes to the
formation of the rectus
sheath
Functions and Actions of the
Anterolateral Abdominal Muscles
1. Form a strong expandable support for the anterolateral
abdominal wall.- all
Facilitate expansion during respiration
2. Protect the abdominal viscera from injury.- all
3. Compress the abdominal contents to maintain or
increase the intra-abdominal pressure and, in so doing,
oppose the diaphragm- oblique and transverse
muscles, acting together bilaterally
expel air during respiration and more forcibly for coughing,
sneezing, nose blowing, voluntary eructation (burping), and
yelling or screaming
produce the force required for defecation, micturition, vomiting,
and parturition.
Transverse incision to
sheath,
subcutaneous tissue
separated from linea
alba. Midline incision
in linea alba
Kstner's incision
Kstner's incision combines the
disadvantages of both midline and
transverse incisions and therefore has
limited utility
Turner-Warwick's incision
Transverse skin incision.
Subcutaneous tissue is
dissected from the
anterior sheath to a point
at least 2 cm below the
pubis.
The sheath is incised 2
cm below the pubis and
at least 4 cm in length.
The incision is extended
cephalad along the
borders of the rectus
muscles.
Peritoneum is incised
longitudinally.
Turner-Warwick incision
provides excellent exposure to the
retropubic space
upper pelvis and abdominal exposure is
severely limited.
McBurney's incision
McBurney's incision
provides excellent access to the ipsilateral
lower quadrant
ideal for appendectomy
easily expanded
cosmesis is excellent
The incision may be placed lower for
extraperitoneal drainage of a pelvic
abscess.
Summary
A detailed knowledge of the anatomy and
function of the anterior abdominal wall is
critically important to the accurate
diagnosis of abdominal and pelvic
pathology as well as the safe practice of
abdominal and pelvic surgery
Thank you
References
Brown, SR, Goodfellow, PB. Transverse verses midline incisions for abdominal
surgery. Cochrane Database Syst Rev 2005; :CD005199.
Fassiadis, N, Roidl, M, Hennig, M, South, LM, Andrews, SM. Randomized clinical
trial of vertical or transverse laparotomy for abdominal. Br J Surg 2005; 92:1208.
Seiler, CM, Deckert, A, Diener, MK, et al. Midline versus transverse incision in
major abdominal surgery: a randomized, double-blind equivalence trial (POVATI:
ISRCTN60734227). Ann Surg 2009; 249:913.
Hendrix, SL, Schimp, V, Martin, J, et al. The legendary superior strength of the
Pfannenstiel incision: a myth?. Am J Obstet Gynecol 2000; 182:1446.
Cox, PJ, Ausobsky, JR, Ellis, H, Pollock, AV. Towards no incisional hernias: lateral
paramedian versus midline incisions. J R Soc Med 1986; 79:711.
Am J Med Genet C Semin Med Genet. 2008 Aug 15;148C(3):180-5.
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