Transverse abdominal muscle, m. transversus abdominis, located under the internal oblique muscle and begins with six teeth from the inner surface of the six lower costal cartilages, a deep leaf fascia thoracolumbalis, labium internum cristae iliacae and the lateral third of the lig. inguinalis. The muscle bundles go in the transverse direction, approach the rectus abdominis muscle and pass into the aponeurosis, forming a line curved outward, linea ...
The deep layer of the anterior abdominal wall consists of the transverse fascia, preperitoneal tissue and peritoneum. The transverse fascia of the abdomen is a thin connective tissue plate, which from the inside is adjacent to the transverse abdominal muscle. Preperitoneal tissue is located between the transverse fascia and the peritoneum. It is more developed in the lower parts of the abdominal wall and passes posteriorly into the retroperitoneal tissue. In the navel area and along ...
Inguinal triangle topography (layer I). 1 - aponeurosis m. obliqui externi abdominis; 2 - a. et v. epigastrica superficialis; 3 - anulus inguinalis superficialis; 4 - crus mediale; 5 - crus laterale; 6 - funiculus spermaticus; 7 - n. ilioinguinalis; 8 - a. et v. pudenda externa; 9 - v. saphena magna; 10 - n….
Inguinal triangle topography (layer II): 1 - aponeurosis m. obliqui extern! abdominis; 2 - m. obliquus internus ab-dominis; 3 - n. iliohypogastricus; 4 - n. ilioinguinalis; 5 - funiculus spermaticus; 6 - a. et v. pudenda externa; 7 - v. saphena magna; 8 - anulus inguinalis superficialis; 9 - m. cremaster; 10 - lig. inguinale….
Inguinal triangle topography (layer III): 1 - aponeurosis m. obliqui externi abdominis; 2 - fascia transversalis; 3 - a. et v. epigastrica inferior; 4 - preperitoneal tissue; 5 - m. cre-master; 6 - funiculus spermaticus; 7 - a. et v. pudenda externa; 8 - v. sa-phena magna; 9 - anulus inguinalis supernciafis; 10 - m….
The posterior surface of the lower part of the anterior abdominal wall: 1 - m. rectus abdominis; 2 - lig. interfoveolare; 3 - anulus inguinalis profundus; 4 - lig. inguinale; 5 - a. et v. epigastrica inferior; 6 - lymph nodes; 7 - lig. lacunare; 8 - a. et v. iliaca externa; 9 - foramen obturatorium; 10 - n. obturatorius; ...
Inguinal gap. A - triangular shape; B - slit-oval shape: 1 - m. rectus abdominis; 2 - aponeurosis m. obliqui externi abdominis; 3 - mm. obliquus internus abdominis et transversus abdominis; 4 - inguinal gap; 5 - lig. inguinale. Between the aponeurosis of the external oblique muscle of the abdomen and the internal oblique muscle, n passes. ilioinguinalis and n. iliohypogastricus….
Forms of the supravesical fossa. A - narrow; B - wide: 1 - plica umbilicalis mediana; 2 - plica umbilicalis medialis; 3 - plica umbilicalis lateralis; 4 - fossa inguinalis lateralis; 5 - fossa inguinalis medialis; 6 - fossa supravesicalis; 7 - ductus deferens; 8 - vesica urinaria. Inguinal canal. Directly above the inguinal ligament is the inguinal canal, ...
The anterior abdominal wall is bounded from above by the costal arches, from below by the inguinal ligaments and the upper edge of the symphysis. It is separated from the posterior abdominal wall by lines running from the anterior ends of the XII ribs vertically down to the crests of the iliac bones. The anterior abdominal wall is divided into three main areas: epigastric, celiac, and hypogastric. The boundaries between these areas are two horizontal lines, one ...
The blood supply to the surface layer is carried out through the six lower intercostal and four lumbar arteries, which are directed to the subcutaneous tissue, perforating the muscle layer. In addition, in the subcutaneous tissue of the lower abdominal wall, the superficial epigastric artery branches, as well as the branches of the superficial artery surrounding the ilium, and the external pudendal artery. Superficial epigastric artery, a. epigastrica superficialis, a branch of the femoral artery, crosses ...
The abdominal wall is divided into antero-lateral and posterior sections. The antero-lateral section is bounded from above by the costal arch, from below - by the inguinal folds, from the sides - by the middle axillary line. Two horizontal lines drawn through the lower points of the tenth ribs and the anterior superior iliac spines, this section of the abdominal wall is divided into three regions: epigastric, celiac and hypogastric. Each of these areas, in turn, is divided by two vertical lines corresponding to the outer edges of the rectus abdominis muscles, into three more areas (Fig. 1).
Anatomically, the antero-lateral abdominal wall consists of three layers. The superficial layer includes skin, subcutaneous tissue and superficial fascia. The middle, muscular, layer in the medial region consists of the rectus and pyramidal muscles of the abdomen, in the lateral - of two oblique (external and internal) and transverse muscles (Fig. 2). These muscles, together with the thoracic-abdominal obstruction, the pelvic diaphragm and the muscles of the posterior abdominal wall, form the abdominal press, the main function of which is to hold the abdominal organs in a certain position. In addition, the contraction of the abdominal muscles provides the acts of urination, defecation, childbirth; these muscles are involved in respiratory, gagging, etc. The oblique and transverse abdominal muscles in front pass into the aponeuroses, which form the sheath of the rectus abdominis muscle and, joining along the midline, the white line of the abdomen. The place of transition of the muscle bundles of the transverse muscle into the tendon is a convex outward line, called the lunate. The posterior wall of the sheath of the rectus abdominis muscle ends below the navel in an arcuate line.
The deep layer of the anterolateral part of the abdominal wall is formed by the transverse fascia, preperitoneal tissue, etc. The remainder of the urinary duct (urachus) passing through the thickness of the tissue, the obliterated umbilical, as well as the lower epigastric vessels form folds on the peritoneum, between which there are depressions, or pits, which are of great importance in the pathogenesis of hernias of the groin region. Of no less importance in the pathogenesis of hernias are the white line of the abdomen and (see).
Rice. 1... Areas of the abdomen (diagram): 1 - left hypochondrium; 2 - left side; 3 - left iliac; 4 - suprapubic; 5 - right ilio-inguinal; 6 -; 7 - right side; 8 - actually epigastric; 9 - right hypochondrium.
Rice. 2. Abdominal muscles: 1 - the front wall of the sheath of the rectus abdominis muscle; 2 - rectus abdominis muscle; 3 - tendon jumper; 4 - internal oblique muscle of the abdomen; 5 - external oblique muscle of the abdomen; b - pyramidal muscle; 7 - transverse; 8 - arcuate line; 9 - crescent line; 10 - transverse abdominal muscle; 11 - white line of the abdomen. The posterior part of the abdominal wall is formed by the lower thoracic and lumbar part of the spine with adjacent ventrally located muscles - the square and iliopsoas and located dorsally - by the extensor muscle and the broad muscle of the back.
The blood supply to the abdominal wall is carried out by the branches of the intercostal, lumbar and femoral arteries, innervation - by the branches of the VII -XII intercostal nerves, ilio-hypogastric and ilio-inguinal. Lymphatic drainage from the integument of the anterior-lateral abdominal wall is directed to the axillary lymph nodes (from the upper abdomen), to the inguinal (from the lower abdomen), to the intercostal, lumbar and iliac lymph nodes (from the deep layers of the abdominal wall).
Borders: from above - costal arches and xiphoid process; below - the iliac crests, inguinal ligaments, the upper edge of the symphysis; outside - a vertical line connecting the end of the XI rib with the iliac crest.
Division into areas
For practical purposes, the anterolateral abdominal wall is divided into three sections using two horizontal lines (the upper one connects the lowest points of the tenth ribs; the lower one - both anterior superior iliac spines) are divided into three sections: the epigastrium, the womb and the hypogastrium. Two vertical lines running along the outer edge of the rectus abdominis muscles, each of the three sections is divided into three areas: the epigastrium includes the epigastric and two subcostal regions; womb - umbilical, right and left lateral regions; hypogastrium - pubic, right and left groin areas.
Organ projections on the anterior abdominal wall
1.the epigastric region- stomach, left lobe of the liver, pancreas, duodenum;
2.right hypochondrium- the right lobe of the liver, the gallbladder, the right bend of the colon, the upper pole of the right kidney;
3.left hypochondrium- fundus of the stomach, spleen, tail of the pancreas, left bend of the colon, upper pole of the left kidney;
4.the umbilical region- loops of the small intestine, transverse colon, lower horizontal and ascending parts of the duodenum, greater curvature of the stomach, kidney gates, ureters;
5.right side area- the ascending colon, part of the loops of the small intestine, the lower pole of the right kidney;
6.pubic area- bladder, lower ureters, uterus, small bowel loops;
7.right groin- cecum, terminal ileum, appendix, right ureter;
8.left groin area- sigmoid colon, small bowel loops, left ureter.
Layered topography
1. Leather- thin, mobile, easily stretched, covered with hair in the pubic region, as well as along the white line of the abdomen (in men).
2. Subcutaneous fat expressed in different ways, sometimes reaches a thickness of 10-15 cm. Contains superficial vessels and nerves. In the lower abdomen, there are arteries that are branches of the femoral artery:
* superficial epigastric artery - directed to the navel;
* the superficial artery that bends around the ilium - goes to the iliac crest;
* the external genital artery - directed to the external genital organs.
The listed arteries are accompanied by veins of the same name that flow into the femoral vein.
In the upper abdomen, the superficial vessels include: the thoracic-epigastric artery, the lateral thoracic artery, the anterior branches of the intercostal and lumbar arteries, and the thoracic-epigastric veins.
Superficial veins form a dense network in the navel area. Through the thoracic-epigastric vein, which flows into the axillary vein, and the superficial epigastric vein, which flows into the femoral vein, anastomoses are carried out between the systems of the superior and inferior vena cava. Veins of the anterior abdominal wall by means of vv. paraumbilicales, located in the round ligament of the liver and flowing into the portal vein, form porto-caval anastomoses.
Lateral cutaneous nerves - branches of the intercostal nerves, pierce the internal and external oblique muscles at the level of the anterior axillary line, are divided into anterior and posterior branches, which innervate the skin of the lateral sections of the anterolateral abdominal wall. Anterior cutaneous nerves - the terminal branches of the intercostal, ilio-hypogastric and ilio-inguinal nerves, pierce the sheath of the rectus abdominis muscle and innervate the skin of the unpaired areas.
3. Superficial fascia thin, at the level of the navel it is divided into two sheets: superficial (passes to the thigh) and deep (denser, attaches to the inguinal ligament). Fatty tissue is located between the leaves of the fascia, and superficial vessels and nerves pass.
4. Own fascia- Covers the external oblique muscle of the abdomen.
5. Muscles the anterolateral abdominal wall is arranged in three layers.
* External oblique muscle the abdomen starts from the eight lower ribs and, going in a wide layer in the medial-inferior direction, attaches to the iliac crest, tucking inward in the form of a groove, forms an inguinal ligament, takes part in the formation of the anterior plate of the rectus abdominis muscle and, merging with the aponeurosis of the opposite side, forms a white line of the abdomen.
* Internal oblique muscle the abdomen starts from the superficial leaflet of the lumbar-dorsal aponeurosis, the iliac crest and the lateral two-thirds of the inguinal ligament and goes fan-shaped in the medial-superior direction, near the outer edge of the rectus muscle turns into an aponeurosis, which above the navel takes part in the formation of both walls of the vagina of the rectus abdominis muscle, below the navel - the front wall, along the midline - the white line of the abdomen.
* Transverse abdominal muscle starts from the inner surface of the six lower ribs, a deep leaf of the lumbar-dorsal aponeurosis, iliac crest and lateral two-thirds of the inguinal ligament. The fibers of the muscle go transversely and pass along the curved crescent (spigelian) line into the aponeurosis, which, above the navel, takes part in the formation of the posterior wall of the vagina of the rectus abdominis muscle, below the navel - the anterior wall, along the midline - the white line of the abdomen.
* Rectus abdominis muscle starts from the anterior surface of the cartilage of the V, VI, VII ribs and the xiphoid process and attaches to the pubic bone between the symphysis and the tubercle. Throughout the muscle there are 3-4 transverse tendon bridges, closely connected with the anterior wall of the vagina. In the epigastric and umbilical regions proper, the anterior wall of the vagina is formed by the aponeurosis of the external oblique and the superficial aponeurosis of the internal oblique muscles, the posterior one by the deep aponeurosis of the internal oblique and the aponeurosis of the transverse abdominal muscles. At the border of the umbilical and pubic regions, the posterior wall of the vagina breaks off, forming an arcuate line, since in the pubic region all three aponeuroses pass in front of the rectus muscle, forming only the anterior plate of its vagina. The back wall is formed only by the transverse fascia.
* White line of the abdomen is a connective tissue plate between the rectus muscles, formed by the interlacing of the tendon fibers of the broad abdominal muscles. The width of the white line in the upper part (at the level of the navel) is 2-2.5 cm, below it narrows (up to 2 mm), but becomes thicker (3-4 mm). Between the tendon fibers of the white line, there may be cracks that are the exit site of hernias.
* Navel formed after the umbilical cord falls off and the umbilical ring epithelializes and is represented by the following layers - skin, fibrous scar tissue, umbilical fascia and parietal peritoneum. Four connective tissue strands converge to the edges of the umbilical ring on the inner side of the anterior abdominal wall:
- the upper cord - the overgrown umbilical vein of the fetus, heading to the liver (in an adult it forms a round ligament of the liver);
- the three lower strands represent a desolate urinary duct and two obliterated umbilical arteries. The umbilical ring may be the exit site of the umbilical hernia.
6. Transverse fascia is a conditionally distinguished part of the intra-abdominal fascia.
7. Preperitoneal tissue separates the transverse fascia from the peritoneum, as a result of which the peritoneal sac easily exfoliates from the underlying layers. Contains deep arteries and veins:
* superior epigastric artery is a continuation of the internal thoracic artery, heading down, penetrates into the sheath of the rectus abdominis muscle, passes behind the muscle and connects to the lower artery of the same name in the navel;
* lower epigastric artery is a branch of the external iliac artery, heading up between the transverse fascia and the parietal peritoneum, enters the sheath of the rectus abdominis muscle;
* deep artery surrounding the ilium, is a branch of the external iliac artery, and parallel to the inguinal ligament in the tissue between the peritoneum and the transverse fascia is directed to the iliac crest;
* five lower intercostal arteries, arising from the thoracic part of the aorta, go between the internal oblique and transverse abdominal muscles;
* four lumbar arteries located between the specified muscles.
Deep veins of the anterolateral wall of the abdomen (vv. Epigastricae superiores et inferiores, vv. Intercostales and vv. Lumbales) accompany (sometimes two) arteries of the same name. The lumbar veins are sources of the azygos and semi-unpaired veins.
8. Parietal peritoneum in the lower parts of the anterolateral wall of the abdomen, it covers the anatomical formations, while forming folds and pits.
Peritoneal folds:
1.median umbilical fold- goes from the top of the bladder to the navel above the overgrown urinary duct;
2.medial umbilical fold (paired)- goes from the lateral walls of the bladder to the navel over the obliterated umbilical arteries;
3.lateral umbilical fold (steam room)- goes over the lower epigastric arteries and veins.
There are pits between the folds of the peritoneum:
1.supracystic fossa- between the median and medial umbilical folds;
2.medial inguinal fossa- between the medial and lateral folds;
3.lateral inguinal fossa- outside of the lateral umbilical folds. Below the inguinal ligament is the femoral fossa, which is projected onto the femoral ring.
These fossae are weak points of the anterolateral abdominal wall and are important in the occurrence of hernias.
The main vessel that provides blood supply to the walls of the abdomen, abdominal organs and retroperitoneal space is the abdominal aorta (aorta abdominalis), which is located in the retroperitoneal space. Unpaired visceral branches of the abdominal aorta supply blood to the organs of the abdominal cavity, and its paired visceral branches carry blood to the organs of the retroperitoneal space and the sex glands. The main venous collectors are represented by v. cava inferior (for the retroperitoneal space and liver) and v. porta (for unpaired abdominal organs). There are numerous anastomoses between the three main venous systems (superior and inferior vena cava and portal veins). The main sources of somatic innervation of the abdominal walls, abdominal organs and retroperitoneal space are the lower 5-6 intercostal nerves and the lumbar plexus. The centers of sympathetic innervation are represented by nucl. intrmediolateralis Th 6 -Th 12, L 1 -L 2 segments of the spinal cord, from where the preganglionic fibers reach the thoracic nodes of the sympathetic trunk and, without switching, form n. splanchnicus major et minor, which pass through the diaphragm and become postganglionic in the second-order vegetative nodes of the abdominal cavity. Preganglionic fibers from the lumbar segments reach the lumbar ganglia of the sympathetic trunk and form nn. splanchnici lumbales, which follow the vegetative plexuses of the abdominal cavity. The centers of parasympathetic innervation are the autonomic nuclei of the X pair of cranial nerves and nucl. parasympathicus sacralis S 2 -S 4 (5) segments of the spinal cord. Preganglionic fibers are switched in the terminal nodes of the peri-organ and intramural plexuses. The main collectors of lymph from these areas are the lumbar trunks (trunci lumbales), as well as the intestinal trunk (truncus intestinalis), which collect lymph from the parietal and visral lymph nodes and flow into the ductus thoracicus.
Abdominal wall
Blood supply the abdominal wall is carried out by superficial and deep arteries. Superficial arteries lie in the subcutaneous tissue. In the lower abdomen are the superficial epigastric artery (a.epigastrica superficialis), heading to the navel, the superficial artery, the circumflex of the ilium (a.circumflexa ilium superficialis), going to the iliac crest, external genital arteries (aa.pudendae to externae), heading external genitals, inguinal branches (rr. inguinales), located in the area of the inguinal fold. The listed arteries are branches of the femoral artery (a. Femoralis).
In the upper abdomen, the superficial arteries are small in size and are the anterior branches of the intercostal and lumbar arteries. The deep arteries are the superior and inferior epigastric arteries and the deep artery that surrounds the ilium. The superior epigastric artery (a.epigastrica superior) arises from the internal chest (a.thoracica interna). Heading down, it penetrates into the sheath of the rectus abdominis muscle, passes behind the muscle and in the navel area connects with the lower artery of the same name. The inferior epigastric artery is a branch of the external iliac artery. It goes up between the fascia transversalis in front and the parietal peritoneum in the back, forming the lateral umbilical fold, and enters the sheath of the rectus abdominis muscle. On the back surface of the muscle, the artery goes up and in the navel it connects to the superior epigastric artery. The lower epigastric artery gives the artery to the muscle lifting the testicle (a. Cremasterica). The deep artery that bends around the ilium (a.circumflexa ilium profunda) is most often a branch of a. iliaca externa and parallel to the inguinal ligament in the tissue between the peritoneum and the transverse fascia is directed to the iliac crest.
Five lower intercostal arteries (aa. Intercostales posteriores), arising from the thoracic part of the aorta, go obliquely from top to bottom and medially between the internal oblique and transverse abdominal muscles and connect to the branches of the superior epigastric artery.
The anterior branches of the four lumbar arteries (aa. Lumbales), from the abdominal aorta, are also located between these muscles and run in a transverse direction, parallel to one another, taking part in the blood supply to the lumbar region. They are connected to the branches of the lower epigastric artery.
Veins the walls of the abdomen are also divided into superficial and deep. Superficial veins are better developed than arteries and deep veins, forming a dense network in the fat layer of the abdominal wall, especially in the navel. They connect with each other and with deep veins. Through the thoracoepigastric veins (vv. Thoracoepigastricae), which flow into the axillary vein, and the superficial epigastric vein (v. Epigastrica superficialis), opening into the femoral vein, the systems of the superior and inferior vena cava are connected (cavacaval anastomoses). Veins of the anterior abdominal wall by means of vv. paraumbilicales, located in the amount of 4-5 in the round ligament of the liver and flowing into the portal vein, connect the v. portae with v. cavae (portocaval anastomoses).
Deep veins of the abdominal wall (vv. Epigastricae superiores et inferiores, vv. Intercostales and vv. Lumbales) accompany (sometimes two) arteries of the same name. The lumbar veins are the sources of the formation of the ascending lumbar veins, which continue into the azygos and semi-unpaired veins.
Lymphatic drainage carried out through the lymphatic vessels located in the surface layers of the anterior-lateral wall of the abdomen and flowing from the upper sections into the axillary (lnn.axillares), from the lower into the superficial inguinal lymph nodes (lnn.inguinales superficiales). Deep lymphatic vessels from the upper parts of the abdominal wall flow into the intercostal (lnn.intercostales), epigastric (lnn.epigastrici) and mediastinal (lnn.mediastinales) lymph nodes, from the lower into the iliac (lnn.iliaci), lumbar (lnn.lumbales) and deep inguinal (lnn.inguinales profundi) lymph nodes. Superficial and deep drainage lymphatic vessels are interconnected. From the listed groups of lymph nodes, lymph is collected in the lumbar trunks (trunci lumbales) and enters the ductus thoracicus.
Innervation the anterolateral abdominal wall is carried out by the branches of six (or five) lower intercostal (subcostal), iliohypogastric (n. iliohypogastricus) and ilio-inguinal (n. ilioinguinalis) nerves. The anterior branches of the intercostal nerves, together with the vessels of the same name, run parallel obliquely from top to bottom and anteriorly, located between m. obliquus internus abdominis and m. transversus and innervating them. Then they pierce the sheath of the rectus muscle, reach the posterior surface and branch out in it.
The ilio-hypogastric and ilio-inguinal nerves are branches of the lumbar plexus (plexus lumbalis). The iliohypogastric nerve appears in the thickness of the anterolateral abdominal wall 2 cm above the anterior superior iliac spine. Further, it goes obliquely down between the internal oblique and transverse muscles, supplying them with branches, and branches in the groin and pubic region. N. ilioinguinalis lies in the inguinal canal parallel to the previous nerve above the inguinal ligament and exits under the skin through the superficial inguinal ring, branching out in the scrotum or labia majora.
In the same layer there are subcutaneous arteries and a vein of the abdomen (a. Et v. Subcutanea abdominis).
The transverse fascia of the abdomen - fascia transversa abdominis - is closely adjacent to the medial surface of the transverse abdominal muscle and is difficult to separate from it. Transverse fascia, preperitoneal tissue (panniculus preperitonealis) and parietal peritoneum are closely connected to one another.
The abdominal wall is formed by only four muscles, of which three - wide lamellar are directed:
a) caudoventrally from the outer surface of the ventral ends of the ribs - the external oblique muscle of the abdomen - m. obliquus abdominis externus;
It covers the upper part of the airway and a minor part of the chest wall approximately to the line of attachment of the diaphragm. In the aponeurosis, the abdominal, pelvic and femoral parts are distinguished. The abdominal part takes part in the formation of the white line and the outer plate of the sheath of the rectus abdominis muscle; behind it is attached to the tubercle of the pubic bone. The pelvic part is thickened and between the points of its attachment (maclok and tubercle of the pubic bone) is called the inguinal, or pipart, ligament (lig. Inguinale). Between it and the end part of the abdominal part of the split aponeurosis, a subcutaneous, or external opening (ring) of the inguinal canal is formed.
Between the inguinal ligament, on the one hand, the anterior edge of the pubic bone and the columnar part of the ilium, on the other, there is a lunate space. The femoral artery, vein and nerve pass through the inner (medial) part of this space.
The femoral part is not expressed in carnivores.
b) the internal oblique muscle of the abdomen - m. obliquus abdominis iriternus;
It has a pronounced tuberous structure. Muscle aponeurosis is involved in the formation of the fascial sheath of the rectus abdominis muscle. Due to the fact that the caudal edge of the muscles in the lower part is not attached to the inguinal ligament, a gap is formed between the muscle and the ligament, which coincides in some part with the external opening of the inguinal canal and has the name of the internal, or abdominal, opening (ring) of the inguinal canal.
The thickest part of the muscle is its beginning, i.e. plot located near the maklok. Between the main part of the muscle and its additional leg, heading to the region of the hungry fossa, there is a narrow gap through which a deep peripheral iliac artery emerges from under the macloc, giving a number of branches into the thickness of the internal and external oblique muscles of the abdomen. The main trunk of this artery runs approximately in the middle of the line connecting the symphysis of the 13th rib with the mice.
The aponeurosis of the muscle near the outer edge of the rectus abdominis muscle is divided into external (ventral) and internal (dorsal) plates, which cover the rectus abdominis muscle, taking part in the formation of its aponeurotic sheath. In the posterior umbilical region, both plates merge and go to the lower surface of the rectus abdominis muscle to the white line.
c) in the dorsoventral direction from the transverse processes of the lower back, the transverse abdominal muscle - m. transversus ab-dominis.
It is the deepest muscle layer of the soft abdominal wall. It begins at the ends of the transverse costal processes of the lumbar vertebrae and on the inner surface of the costal wall near the line of attachment of the diaphragm and has a vertical direction of muscle fibers. Near the level of the transition of the lateral abdominal wall to the ventral muscle part, it turns into a thin aponeurosis, heading along the dorsal surface of the rectus abdominis muscle to the white line, in the formation of which it takes part. The muscle is loosely connected to the internal oblique muscle of the abdomen and is very firmly adhered to the transverse fascia of the abdomen.
All three muscles pass into rather wide aponeuroses, which are connected (sutured) along the midline of the abdomen with the similar muscles of the other side. A white line of the abdomen is formed - linea alba. This is a narrow elongated fibrous triangle formed from the fusion of the aponeuroses of the abdominal muscles, yellow and transverse fascia, and stretching from the xiphoid cartilage to the pubic fusion. Approximately in the middle of the white line there is a thickened scar area - the navel.
Distinguish between the pre-umbilical and post-umbilical parts of the white line of the abdomen; the first of them is much wider than the second and distinguishes between the dorsal and ventral surfaces. The width of this part of the white line makes it possible to penetrate into the abdominal cavity (with a median laparotomy) without damaging the aponeurotic sheaths of the rectus abdominis muscles. The posterior umbilical part of the white line is very narrow; reinforced by the unpaired pubic tendon of the abdominal muscles, which forms the so-called triangular ligament. This ligament has two branches that attach to the ilio-scallop tubercles. Between these branches and the anterior edge of the pubic bones, there is a gap through which the external pudendal artery and vein pass. The opening is closed by a somewhat thickened transverse fascia.
d) rectus abdominis muscle - m. rectus abdominis has a direction from front to back, runs along the white line between the aponeuroses of the external and internal oblique abdominal muscles, starting from the surface of the costal cartilage and ending at the pubic crest of the pubic bone. This muscle along the way has transverse tendon bridges.
Along the posterior edge of the lower end of the 8th costal cartilage, the cranial epigastric artery and vein penetrate from the chest cavity into the thickness of the rectus abdominis muscle. Cranial epigastric artery - a. epigastrica cranialis, which is a continuation of the internal thoracic artery, goes near the midline of the dorsal surface of the muscle and gives off 7-8 large branches in both directions. Gradually thinning, the artery is lost in the navel. The caudal epigastric artery (a branch of the epigastric-pudendal trunk) penetrates into the posterior segment of the muscle, at the level of the knee fold, from the aponeurosis of the transverse muscle of the abdomen. This artery, more powerful than the cranial epigastric artery, also runs along the dorsal surface of the rectus abdominis muscle, to the navel.
Blood supply to the abdominal wall
The blood supply to the abdominal wall is provided by: a) branches of the saphenous artery of the abdomen (from the external pudendal artery); b) partly by the branches of the external thoracic artery; c) intercostal arteries; d) lumbar arteries, the main trunks of which pass between the transverse and internal oblique abdominal muscles; e) the deep iliac artery encircling, from the latter two branches extend to the hungry fossa and the area of the iliac proper; f) cranial and caudal epigastric arteries going one towards the other inside the rectus sheath along its dorsolateral edge. The first of them is a continuation of the internal thoracic artery, and the second departs from the epigastric-pudendal trunk (truncus pudendo-epigastricus).
The ventral branches of the lumbar arteries, six in number, run parallel to each other along the outer surface of the transverse abdominal muscle.
Innervation. All layers of the abdominal wall are innervated by the thoracic nerves, mainly by their ventral branches (intercostal nerves, from the 7th to the last), as well as by the dorsal and ventral branches of the lumbar nerves. The ventral branch of the last thoracic nerve (last intercostal nerve) reaches the caudoventral iliac region. The dorsal branches of the lumbar nerves innervate the skin of the region of the hungry fossa; their ventral branches (ilio-hypogastric, ilio-inguinal and external spermatic nerves) innervate all layers of the rest of the ilia, groin, prepuce, most of the udder and scrotum.
The last intercostal nerve runs parallel to the last rib and retreats from it by 1-1.5 cm; below the distal end of the last rib, it continues in the same direction, i.e. caudoventrally. The lateral and medial branches of the iliohypogastric nerve, running along the corresponding surfaces of the transverse abdominal muscle, are located parallel to the last intercostal nerve along the border between the anterior and middle third of the lateral abdominal wall. Both branches of the ilio-inguinal nerve stretch parallel to the ilio-hypogastric nerve, at an equal distance from it and from the anterior edge of the fascia lata tensor, which corresponds to the border between the middle and posterior third of the lateral soft abdominal wall.
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