ANTERIOR ABDOMINAL WALL

BY: DR RAHEEL AHMAD

 SKIN
NERVE SUPPLY:
 Derived from the anterior rami of lower six thoracic and the
first lumbar nerve.
 Thoracic nerves are the lower five intercostal and subcostal
nerves, the first lumber nerve is represented by the
iliohypogastric and the ilioinguinal nerves.
 Dermatome of T7 is located in epigastrium over the xiphoid
process
 Dermatome of T10 includes the umbilicus
 Dermatome of L1 lies just above the inguinal ligaments and
the symphysis pubis
 BLOOD SUPPLY
ARTERIES:
 The skin near the midline is supplied by branches of the superior and
inferior epigastric arteries.
 This artery enters in upper part of rectus sheath between the sternal
and costal origins of diaphragm. It descends behind the rectus
abdominus muscle, supplying the upper central part of anterior
abdominal wall and anstamoses with the inferior epigastric artery.
 The inferior epigastric artery is branch of the external iliac artery just
above the inguinal ligament, which runs upward and medially along
the medial side of inguinal ring.
 It ascends behind the rectus muscle and supplying the lower central
part of anterior abdominal wall.
 CONTT….
• The skin of the flanks is supplied by branches of the
intercostal, the lumbar and deep circumflex iliac
arteries.
• Deep circumflex artery is branch of external iliac
artery just above the inguinal ligament and supplying
the lower lateral part of the abdominal wall.
• The intercostal arteries, branches of thoracic aorta
and the four lumbar arteries branches of the
abdominal aorta pass forward between the muscle
layers and supply lateral parts of the abdominal wall.
 CONTT….
VEINS:
 Superficial veins form a network that radiates
out from the umbilicus.
 Above the network is drained into the axillary
vein via the lateral thoracic vein and below
into the femoral vein via the superficial
epigastric and the great saphenous veins.
 SUPERFICIAL FASCIA
 Divided into superficial fatty layer (Fascia of camper)
and the deep Membranous layer (Scarpa’s Fascia)
 Fatty layer is continuous with superficial fascia over
the rest of the body.
 Membranous layer fades out laterally and above.
 Inferiorly membranous layer passes over the inguinal
ligament to fuse with the deep fasciaof the thigh.
 In the midline it is not attached to pubis but instead
forms a tubular sheath for penis (clitoris)
 CONTT….
• In the perineum it is attached on each side to
the margins of pubic arch and is known as
Colles’ Fascia.
 DEEP FASCIA
• In the anterior abdominal wall the deep fascia
is a thin layer of areolar tissue covering the
muscles.
MUSCLES OF ANTERIOR ABDOMINAL WALL

The muscles of abdominal wall consist of:

 External oblique muscle
 Internal oblique muscle
 Transversus
 Rectus abdominus
 Pyramidalis
 EXTERNAL OBLIQUE MUSCLE

 Broad, thin muscular sheet that arises from

the outer surface of lower eighth rib and fades
out to be inserted into the xiphoid process,
linea alba, and pubic crest.
 Nerve supply is lower 6 thoracic nerves and
ilioinguinal nerve.
 INTERNAL OBLIQUE
 Broad, thin, muscular sheet that lies deep to the
external oblique, most of its fibers runs at right
angle to those of external oblique.
 The muscles arises from the lumbar fascia, iliac
crest, lateral two third of inguinal ligament.
 The muscle is inserted in the lower border of the
lower three ribs and their costal cartilages,
xiphoid process, linea alba, and symphysis pubis.
 TRANSVERSUS
 Thin sheet of muscle that lies deep to internal
oblique and its fibers runs horizontally
forward.
 It arises from the lower six costal cartilages,
lumbar fascia, anterior two third of iliac crest,
and the lateral third inguinal ligaments.
 It is inserted into xiphoid process, linea alba,
and symphysis pubis.
 RECTUS ABDOMINUS
 Long strap muscle that extends along the whole
length of the anterior abdominal wall.
 Arises from front of symphysis pubis and from
the pubic crest.
 Have an insertion in fifth, sixth and seventh
costal cartilage and xiphoid process.
 it is enclosed between the aponeuroses of the
external oblique, internal oblique and
transversus, which form rectus sheath.