Features of the structure of the muscles of the front abdominal wall. Topographic anatomy of the anterior abdominal wall

The date: 03.03.2020

The walls of the abdominal cavity - so in the medical literature indicate a set of muscles, aneucroids and fascia, which serve as a person to keep the abdominal organs and protect them the effects of external factors.

The walls of the abdominal cavity are separated on the upper (consists of a diaphragm - the muscle that shares the abdominal and chest cavity and serves to expand the lungs) the front and rear walls, as well as on the rear and side walls. They consist of skin cover, as well as from the muscles of the abdominal press.

The side walls of the belly form three large muscles:
- outer melting muscle;
- inner oblique muscle;
- transverse muscle;

The front wall consists of a straight abdominal muscle, as well as a pyramid muscle. The rear wall consists of a square muscle of the lower back.

The peritoneum is a translucent sheath of serous fabric, which covers the plane of the internal organs, as well as the inner walls of the abdominal cavity. Also, the peritoneum is the most deep layer of all the walls of the abdomen.

Front wall

The front wall consists of several layers, among which: leather, subcutaneous fiber, fascia (connecting shells, covering organs form muscle cases), predominant tissue, as well as muscles and the peristin itself.

The skin here is quite elastic and very thin, it is easily amenable to various movements, folds. Subcutaneous fabric contains a large amount of fatty sediments. Especially quite a few fatty tissues are present at the bottom of the abdomen.

The front wall is equipped with a large number of nerve endings and blood vessels, there are also lymphatic nodes (organs that perform the filter function; an increase in nodes means that the body is subject to illness; nodes are an obstacle for infections, as well as cancer).

The front abdominal wall is conventionally divided into three areas: grade, cranky and supred.

Back wall

The back wall consists of the bottom chest and the lumbar portion of the spine, as well as the muscles adjacent to them: the square muscle, the iliac-lumbar muscle, the wide muscles of the back, as well as from the muscle that is spinning the spine.

Behind the abdominal walls are the following organs: stomach, gallbladder, liver, spleen, as well as intestine (skinny, iliac, sigmoid, blind, appendix). In the retroperitoneal space also lie: kidneys, pancreas, adrenal glands, as well as ureterals and duodenal gut.

The muscles of the front wall of the abdomen, especially in four-legged primates, are subject to strong loads that require a certain force from muscles, and it can be developed by performing various exercises.

If the muscles of the front wall of the abdomen are not subject to any loads, it can lead to its deformation. The most common deformation is obesity. It can also be caused by improper nutrition and disorders of the organism endocrine system.

The deformations may also occur due to the accumulation of a large amount of fluid directly in the abdominal cavity, this disease is called ascites. This may accumulate more than 20 liters of fluid. This causes many problems: in digestion, in the work of the heart and lungs, as well as severe legs of the legs and cough. The cause of ascites may be cirrhosis (75%) of the liver or cancer.

In pregnant women and other primates, the front wall is often susceptible to frequent and strong loads, it is quite stretched. Permanent workouts will allow to protect the front wall from various kinds of deformations. Sports exercises, like flexion and extension of the muscles of the press perfectly help maintain muscles in excellent shape.

However, it is impossible to strongly overload the muscles of the anterior abdominal cavity, as the hernia of the belly may be manifested (the exit of the peritoneum organs from the cavity into anatomical formation under the skin).

Aneucroxes are tendon plates, which consist of dense, durable collagen and elastic fibers. In the aneurzes there are almost no blood vessels, as well as nervous endings. The most significant are the aneucroids of the front wall. Aneucroids have a white-silver color, which is slightly glorifying, a large amount of collagen.

In the structure of the aneurhroza, quite similar to the tendons.

The aneurms will grow together with each other and thus form the so-numbered white line of the abdomen. The white belly line is a fibrous structure that is located right on the middle vertebrate line. It shares the right and left abdominal muscles. Like other aneurms, the white belly line is practically devoid of blood vessels and nerve endings. In this area, fat is completely absent.

Since it is practically devoid of vessels and nerve endings, it is very often amenable to surgical cuts in operations in the abdominal field.

The transverse muscle of the abdomen, m. TransVersus Abdominis is located under the inner oblique muscle and begins six teeth of the inner surface of the six lower rib cartilage, deep leaflet Fascia ThoracolumBalis, Labium Internum Cristae Iliacae and Lateral Three Lig. inguinalis. Muscular bundles go in the transverse direction, approach the straight muscle muscle and go to aponeurosis, forming a curved duck line, Linea ...

The deep layer of anterior abdominal wall consists of transverse fascia, predominant fiber and peritoneum. The transverse belly fascia is a thin connective tissue plate, which from the inside goes to the transverse muscle of the abdomen. Prettartal fiber is located between the transverse fascia and peritoneum. It is more developed in the lower departments of the abdominal wall and passes the stop in the retroperitoneal fiber. In the field of navel and along ...

Patch triangle topography (I layer). 1 - aponeurosis m. Obliqui externi abdominis; 2 - a. ET V. Epigastrica Superficialis; 3 - Anulus Inginalis 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 ....

Topography of the inguinal triangle (II layer): 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 Inginalis Superficialis; 9 - m. Cremaster; 10 - Lig. Inguinale ...

Patch triangle topography (III layer): 1 - aponeurosis m. Obliqui externi abdominis; 2 - Fascia Transversalis; 3 - a. ET V. Epigastrica Inferior; 4 - predominant fiber; 5 - m. CRE-MASTER; 6 - FUNICULUS SPERMATICUS; 7 - a. ET V. Pudenda Externa; 8 - v. SA-Phena Magna; 9 - Anulus Inginalis Supernciafis; 10 - m ....

The rear surface of the lower vehicle of the front abdominal wall: 1 - m. Rectus abdominis; 2 - Lig. interfoveolare; 3 - Anulus Inginalis Profundus; 4 - Lig. Inguinale; 5 - a. ET V. Epigastrica Inferior; 6 - lymphatic nodes; 7 - Lig. lacunare; 8 - a. ET V. Iliaca Externa; 9 - FORAMEN OBTURATORIUM; 10 --n. Obturatorius; ...

Packing gap. A - triangular form; B - a pussy-oval form: 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 outer oblique muscle of the abdomen and the inner oblique muscle passes N. ilioinguinalis and n. iliohypogastricus ....

Forms of an appearance. A - narrow; B - Wide: 1 - Plica Umbilicalis Mediana; 2 - Plica Umbilicalis Medialis; 3 - Plica Umbilicalis Lateralis; 4 - Fossa Inginalis Lateralis; 5 - Fossa Inginalis Medialis; 6 - Fossa SupraveSicalis; 7 - Ductus Deferens; 8 - Vesica Urinaria. Packing canal. Directly above the groin ligament is a groin canal ...

The front abdominal wall is limited from top of the rib arcs, from below - in the inguinal ligaments and the upper edge of the alphabet. From the back of the abdominal wall, it is separated by lines going from the front ends of the XII edges vertically down to the ridges of the iliac bones. The front abdominal wall is divided into three main areas: tast, cereal and grated. The borders between these areas are two horizontal lines, one ...

The blood supply to the surface layer is carried out by the six lower intercostal and four lumbar arteries, which are sent to the subcutaneous tissue, proceeding the muscular layer. In addition, in the subcutaneous tissue of the underlying of the abdominal wall, the surface superstructure of the artery is branched, as well as the branches of the surface artery surrounding the iliac bone, and the outer sake artery. Surface asshole artery, a. Epigastrica Superficialis, branch of the femoral artery, crosses ...

In the same layer there are subcutaneous artery and belly vein (a. Et v. Subcutanea abdominis).

The transverse fascia of the abdomen - Fascia Transversa Abdominis - closely adjacent to the medial surface of the transverse muscle of the abdomen and with difficulty from it separa. Transverse fascia, preprichly fiber (Panniculus preperitonealis) and the closed peritonean is closely connected one on the other.

The abdominal wall form only four muscles, of which three are wide, lamellar are sent:

a) Caudomatrally from the outer surface of the ventral ends of the ribs - the outer oblique muscle of the abdomen - m. Obliquus abdominis externus;

It covers the top of the illeg and insignificant: the pectoral section is about to attach a diaphragm. In aponeurosis distinguish the abdominal, pelvic and poor parts. The abdominal part takes part in the formation of a white line and the outer plate of the vagina's direct abdominal muscle; It is attached to the bumps of the lane. The pelvic part is thickened and between points of its attachment (Maclock and Lonny Bud) is called groin, or tipparent, ligament (Lig. Inguinale). Between it and the final part of the abdominal department of the split aponeurosis is formed subcutaneous, or the outer opening (ring) of the inguinal channel.

Between the groove bunch, on the one hand, the front edge of the lane and the column part of the ileum, on the other hand, remains the space of the semi-lift. Through the inner (media) part of this space pass the femoral artery, Vienna and the nerve.

The femoral part in carnivorous animals is not expressed.

b) Cranevotrally from the base of the McLock, the inner oblique muscle of the abdomen - m is diverged. Obliquus abdominis iriternus;

It has a pronounced pure structure. The muscle's aponeurosis takes part in the formation of the fascial vagina direct abdominal muscle. Due to the fact that the caudal region of the muscles in the lower part is not attached to the groove bunch, the slot is formed between the muscle and the bundle, which coincides in some part with the outer opening of the inguinal channel and having the name of the internal, or abdominal, holes (rings) of the inguinal channel.

The thick part of the muscle is its beginning, i.e. Plot located near McLock. Between the main part of the muscle and its additional leg heading into the area of \u200b\u200bthe hungry fossa, there is a narrow slit through which a deep circumferential ileum, which gives a number of branches in the thickness of the inner and outdoor muscles of the abdomen. The main trunk of this artery is located approximately in the middle of the line connecting the symphiz of the 13th rib with the Macket.

Uponeurosis of the muscle near the outer edge of the direct muscle of the belly is divided into outer (ventral) and inner (dorsal) plates that cover the straight muscle of the abdomen, taking part in the formation of its aponeurotic vagina. In the early pressure area, both plates merge and go to the bottom surface of the direct muscle of the belly to the white line.

c) In the dorsovetral direction from the transverse processes of the lower back, the transverse muscle of the abdomen is going - m. TRANSVERSUS AB-DOMINIS.

It is the deepest muscular layer of soft abdominal wall. It begins at the ends of transverse-ribrous processes of lumbar vertebrae and on the inner surface of the rib wall near the diaphragm attachment line and has a vertical direction of muscle fibers. Near the transition of the lateral abdominal wall in the ventral muscle part turns into thin aponeurosis, heading along the dorsal surface of the direct muscle of the belly to the white line, in the formation of which it takes part. Muscles loosely connected to the inner oblique muscle of the abdomen and very firmly combed with the transverse fascism of the belly.

All three muscles go into fairly wide aponeurosis, which in the middle line of the abdomen are connected (stitched) with the co-muscles of the other side. A white belly line is formed - Linea Alba. This is a narrow elongated fibrous triangle, formed from the fusion of the abdominal muscles, yellow and transverse fascia and stretching from the sword-shaped cartilage to the Lona Self. Around the middle of the white line there is a compacted scar site - navel.

Distinguish between the preprocessing and overpooting parts of the white line of the abdomen; The first of them is significantly wider than the second and it is distinguished by the dorsal and ventral surface. The width of this part of the white line makes it possible to penetrate the abdominal cavity (with median laparotomy), without damaging the aponeurotic vagina of the live muscles of the abdomen. Beading the white line is very narrow; Reinforced by the unpaired pubic tendon of abdominal muscles, which forms the so-called triangular ligament. This bunch has two branches attached to the iliac-scallop tubercles. There is a slot between these branches and the front edge of the wicked bones through which the outdoor sinking artery and vein pass. The hole is closed by several thickened transverse fascia.

d) straight abdominal muscle - m. Rectus abdominis has a direction from the front back, goes along a white line between the aponeurosis of the outer and inner oblique abdominal muscles, starting from the surface of the rib cartilage and ending on the lane ridge. This muscle in the course has transverse tendon jumpers.

At the rear edge of the lower end of the 8th rib cartilage from the thoracic cavity to the crowd of a straight muscle of the belly penetrate the cranial asshole artery and vein. Cranial nasty artery - a. Epigastrica Cranialis, which is a continuation of the inner chest artery, goes near the midline of the dorsal surface of the muscle and gives 7-8 large branches in both directions. Gradually dropping, the artery is lost in the navel area. In the back of the muscle, at the level of the knee fold, the caudal asshole artery (the branch of the asshole-stenular trunk) penetrates with the aponeurosis of the transverse muscle. This artery, more powerful than the Cranial Nadium Artery, also goes along the dorsal surface of the direct muscle of the abdomen, in the navel area.

Blood supply of the abdominal wall

The blood supply to the abdominal wall is ensured: a) the branches of the subcutaneous artery of the abdomen (from the outer plunge artery); b) partly branches of the outer thoracic artery; c) intercostal arteries; d) lumbar arteries, the main trunks of which pass between the transverse and inner oblique abdominal muscles; d) a slimming deep iliac artery, two branches will be departed from the latter to the hungry fossa and the region itself; (e) Crane and caudal supraity arteries, going one towards the other inside the vagina direct muscle along its dorsolteral edge. The first of these is the continuation of the inner chest artery, and the second is departed from the TRUNCUS Pudendo-EpigaStricus).

The ventral branches of the lumbar arteries in the amount of six pass in parallel to each other along the outer surface of the transverse muscle of the abdomen.

Innervation. All layers of the abdominal wall are innervated by pectoral nerves, mainly their ventral branches (intercostal nerves, starting from the 7th to the last), as well as the dorsal and ventral branches of lumbar nerves. The ventral branch of the last breast nerve (the last intercutor nerve) reaches the caudoentral department of the iliac region. The dorsal branches of lumbar nerves innervate the skin of the area of \u200b\u200bthe hungry hole; Ventral branches (iliac-grated, iliac-groove and outer seed nerves) innervate all layers of the rest of the left side, groin, prepositions, most of the udder and scrotum.

The last intercostal nerve goes parallel to the last edge and retreat from it by 1-1.5 cm; Below the distal end of the last rib, it continues in the same direction, i.e. Caudoventral. The lateral and medial branches of the iliac-grave nerve, which goes on the appropriate surfaces of the transverse muscle of the abdomen, are located in parallel to the last intercostal nerve along the border between the front and medium third side abdominal wall. Both branches of the iliac-inhabitant nerve stretch parallel to the ileal-grade nerve, at an equal distance from it and from the front edge of the thigh wide fascia, which corresponds to the border between the middle and the rear third side soft abdominal wall.

Borders: from above - rib arcs and a mammerous process; Below - iliac ridges, inguinal ligaments, the top edge of the symphima; Outside - the vertical line connecting the end of the XI rib with the iliac row.

Division on the area

With a practical goal of the front wall of the abdomen with the help of two horizontal lines (the top connects the lowest points of the tenths; Lower - both front Upper iliac aksuch) divide into three departments: Nadchrezhevye, wheel and framed. Two vertical lines going on the outer edge of the abdominal muscles, each of the three departments is divided into three areas: Suchrezhe region includes the ass and two hypochrites; The womb - the umbilical, right and left side areas; Grace - pubic, right and left inguinal areas.

Projections of organs on the front abdominal wall

1. Supported area- stomach, left fraction of liver, pancreas, duodenum;

2. Right hypochondrier- the right share of the liver, gallbladder, the right bending of the colon, the upper pole of the right kidney;

3. Legal hypochondrier- the bottom of the stomach, spleen, the tail of the pancreas, the left bending of the colon, the upper pole of the left kidney;

4. Underfloor area- loops of the small intestine, transverse colon, lower horizontal and ascending parts of the duodenum, a large curvature of the stomach, gate of the kidneys, ureters;

5. Right side area- ascending colon, part of the loop of the small intestine, the lower pole of the right kidney;

6. Lobcovaya oblast- bladder, bottom departments of ureters, uterus, loops of the small intestine;

7. Right groin area- blind intestine, the final department of the iliac, a heart-shaped process, right ureter;

8. Left Packing Region- Sigmoid gut, loops of the small intestine, left ureter.

Layered topography

1. Leather - Thin, movable, easily stretched, covered with hair in the pubic area, as well as on the white belly line (in men).

2. Subcutaneous fat fiberit is expressed in different ways, sometimes it reaches 10-15 cm in thickness. Contains surface vessels and nerves. In the lower sector of the abdomen are arms, which are branches of the femoral artery:

* Surface superficial artery - directs to Pup- ku;

* Surface artery, envelope iliac bone - goes to a iliac row;

* Outdoor sexual artery - sent to outdoor genital organs.

The listed arteries are accompanied by the veins of the same names falling into a femoral vein.

In the upper stomach departments to the surface vessels include: pendant artery, sideways, the front branches of intercostal and lumbar arteries, and sore veins.

Surface veins form in the navel area, a thick network. Through the pendant veins, flowing into the armpit vein, and the superficial venu, flowing into the femoral vein, are carried out anastomosis between the systems of the upper and lower hollow veins. Vienna front abdominal walls via VV. Paraumbilicales, located in a round bunch of liver and flowing into a portable vein, form port-cavalny anastomoses.

Lateral skin nerves - branches of intercostal nerves, the inner and outer oblique muscles at the level of the front axillary line are divided into the front and rear branches, innervating the skin of the lateral departments of the front abdominal wall. The front skin nerves are the final branches of intercostal, iliac-grave and iliac-inhabitants, the vagina's direct muscles of the abdomen and the innerware of the skin of the unpaired regions are performed.

3. Surface Fasciathin, at the level of the navel is divided into two sheets: superficial (moving on the thigh) and deep (more denser, attached to the groove bundle). There is a fatty tissue between the fascia sheets, and surface vessels and nerves pass.

4. Own fascia- covers the outdoor oblique muscle.

5. Musclesthe abdominal walls are located in three layers.

* Outer oblique musclethe belly begins from eight lower edges and, walking with a wide layer in the medial-lower direction, attached to the ridge of the iliac bone, turning inside in the form of a groove, forms inguinal ligament, takes part in the formation of the front plate of the straight muscle of the abdomen and, fightering with the aponeurosis of the opposite side, Forms a white belly line.

* Inner oblique musclethe abdomen begins on the surface sheet of the lumbly aponeurosis, the ileal ridge and the lateral two-thirds of the groin bond and goes fanlike in the medial-upper direction, near the outer edge of the direct muscle turns into aponeurosis, which above the navel takes part in the formation of both walls of the vagina's direct abdominal muscle, Below the navel is the front wall, along the midline - the white line of the abdomen.

* Transverse abdominal muscleit begins on the inner surface of the six lower edges, a deep leaflet of the lumbly aponeurosis, a iliac crest and the lateral two-thirds of the groin ligament. Muscle fibers go crosswise and move along the curved semi-lunut (spegor) line in the aponeurosis, which above the navel takes part in the formation of the rear wall of the vagina's straight abdominal muscle, below the navel - the front wall, on the midline - the white line of the abdomen.

* Straight abdominal muscleit begins from the front surface of the cartilage V, VI, VII ribs and a sword-shaped process and is attached to the pubic bone between the symphysome and a tubercle. Through the muscles there are 3-4 transversely reaching tendon jumpers, closely related to the front wall of the vagina. In the opposite wall of the vagina, the front wall of the vagina forms the aponeurosis of the outer oblique and the surface sheet of the aponeurosis of the inner oblique muscles, the back - deep leaflet of the aponeurosis of the inner oblique and the aponeurosis of the abdominal muscles. At the border of the umbilical and pubic regions, the rear wall of the vagina breaks down, forming an arcuate line, since in the pubic area all three aponeurosis go on the front from the straight muscle, forming only the front plate of its vagina. The rear wall forms only transverse fascia.

* White belly lineit is a connective tissue plate between straight muscles, formed by weave the tendon fibers of wide abdominal muscles. The white line width in the upper part (at the navel level) is 2-2.5 cm, below it is narrowed (up to 2 mm), but becomes thicker (3-4 mm). Between the tendral fibers of the white line can be slots, which are the place of the yen.

* Pup It is formed after the pupil and epithelism of the umbilical ring and is represented by the following layers of leather, fibrous scar tissue, umbilical fascia and parietal peritoneum. To the edges of the umbilical rings on the inside of the front wall of the belly converge four connective tissues:

- upper heavy - overgrown biproom vein of the fetus, heading for the liver (in an adult forms a round ligament of the liver);

- Three lower strands are opposed by the urinary duct and two oblumbrated nuclear arteries. The umbilical ring can be the outlet of the navel hernia.

6. Transverse fasciait is a conditionally allocated part of intra-abdominal fascia.

7. Prettartal fiberseparates the transverse fascia from the peritoneum, as a result of which the brush bag is easily peeling from the pre-layers. Contains deep arteries and veins:

* Upper painful arteryit is a continuation of the inner thoracic artery, heading down, penetrates the vagina the direct muscle muscle, passes behind the municipality and in the navel area is connected to the bottom artery of the same name;

* Lower asshole It is the branch of the outer iliac artery, heading up between the transverse fascia and parietal peritoneum, enters the vagina the straight muscle of the abdomen;

* Deep artery, envelope iliac boneis a branch of the outer iliac artery, and parallel to the groin bond in the fiber between the peritoneum and transverse fascia is sent to the iliac row;

* Five lower intercostal arteries, arising from the thoracic part of the aorta, go between the inner oblique and the transverse muscles of the abdomen;

* Four lumbar arterieslocated between the specified muscles.

Deep veins of the front abdominal wall (VV. Epigas-Tricae Superiores et Inferiores, VV. Intercostales and VV. Lumbales) accompany (sometimes two) arteries. Lumbar veins are sources of unpaired and semi-regional veins.

8. Parietal Perjun In the lower departments of the front abdominal wall covers anatomical formation, forming folds and pits.

Pushlasts:

1. Middle Undermines- comes from the top of the bladder to the navel over the overgrown urine duct;

2. Medial Underground Fold (Pair) - It comes from the side walls of the bladder to the navel over oblised umbilical arteries;

3. Lateral Underlands (Pair) - It goes over the bottom left arteries and veins.

Between the folds of the peritoneum are pits:

1. Outpunny yams - between the median and medial umbilical folds;

2. Medical inguinal pits - between media and lateral folds;

3. lateral inguinal yams - Outside from lateral umbilical folds. Below the groove ligament is a femoral fossa, which is projected on the femoral ring.

These fots are weak places of the abdominal wall and matter when the hernia occurs.

Topographic anatomy of the anterior abdominal wall.

Surgery hernia.

Front abdominal wall areas

2 Horizontal lines (Linea Bicostarum et Linea Bispinarum) divide the front abdominal wall at 3 departments: I - Nadda; II - wield; III - gravel

2 vertical lines passing

According to the outer edge of direct muscles, departments on the region are divided:

Nadchrevye: 1 - Nadred; 2 - left and right hymen.

Curb: 3 - Underground; 4 - left and right side.

Grace: 5 - Lobcovaya; 6 - left and right inguinal.

The structure of the front abdominal wall

Layers: Skin - thin, Easy stretching; PJK -

expressed individually; Surface Fascia -

Below the navel is split into 2 sheets;

own fascia; muscles - external and internal

oblique, transverse, straight; Fascian Endoabdomalis; PERSONALLY FILLING; Parietal peritonean

Blood supply. The arteries have longitudinal and transverse directions and distinguish:

Surface: superficial surface; superficial, envelope iliac bone; Branches of the external genital and surface branches of intercostal

Deep: Upper left; lower left;

deep, envelope iliac bone; 6 lower intercostal; 4 lumbar

Innervation (nerves only oblique direction): 6 lower intercostal; iliac-grained nerve; iliac-groove nerve

Vagina direct abdominal muscles

Above navel:

Front wall:

Uponeurosis outer + front sheet of aponeurosis inner oblique muscle

Back wall:

Rear sheet of aponeurosis internal oblique + progress of the transverse muscles + transverse fascia

Below navel:

Front wall:

Aponeurosis outer + internal oblique + aponeurosis of transverse muscles

Back wall:

Cross fascia

Access to the abdominal organs (laparotomy)

Separation groups:

longitudinal;

transverse;

oblique;

corner;

Combined.

The inner surface of the front abdominal wall

Pushlasts:

PLICA Umbilicalis Mediana (unpaired) - the fold of the peritoneum over the overgrown blade -1;

Plica Umbilicalis Medialis (pair) - fold over refuser. Umbilicalis - 2;

Plica Umbilicalis Lateralis (pair) Pushka's folds over a. and v. Epigastrica Inferior - 3.

Between the folds of the peritoness

Pile:

Fossa SupraveSicalis - 1;

Medial Packing Pack, Fossa Inginalis Medialis - 2;

Lateral girlfriend, Fossa Inginalis Lateralis - 3.

Below the groin fold is a femoral fossa, Fossa Femoralis - 4.

The pits are the place of hernia.

Weak vests of the abdominal wall

- These are places where there are holes or cracks in fascia and aponeurosis or between the edges of the muscles and where the absence of some elements of the muscular-aponeurotic layers of the abdominal wall is observed.

allocate:

1) holes and slots in the white line of the abdomen

2) Uphill Ring

3) Front abdominal walls (forehead, medial, lateral, femoral)

4) spegor line

White belly line

Formed by the weave of tendral fibers of the aponeurosis of all three pairs of wide abdominal muscles

It stretches from a sword-shaped process to a pubic symphiz. Length - from 30 to 40 cm. The width is different: the sword-shaped process is 0.5 cm, then it expands and at the navel level - 2-3 cm. The thickness above the navel is 1-2 mm, below the navel - 3-4 mm.

With a long-term increase in the volume of the abdominal cavity, the tendral fibers of the white line can stretch and move out, which leads to the formation of weak points.

White line hernias are more likely to appear above the navel, where the white line is thin and wide

Navel area

The rotten scar on the site of the umbilical ring.

Basic ring -Closer in a white line with sharp and smooth edges formed by tendon fibers of the aponeurosis of all widespread abdominal muscles. In the intrauterine period passes a poodulous rope connecting the fruit with the mother's organism.

The layers in the field of the navel consist of tightly fragmented among themselves:

skin;

scar tissue;

transverse (umbilical) fascia;

peritoneum.

Anatomical features predispose to the formation of naughty hernia are:

increasing ring diameter;

incomplete closure of its umbilical fascia;

The presence of pure diverticulus in the umbilical rings area (more often occurs in men).

Packing canal

Located in the field of inguinal triangle

Border of the inguinal triangle:

From above - horizontal line h / s border between the middle and outer 1/3 of the groove bunch;

From the inside - the outer edge of the straight muscle of the abdomen;

Outside from below - a groin bunch.

The channel has 2 rings:

Surface (formed aponeurosis fibers The outer oblique abdominal muscle, which are split into two legs)

Deep (corresponds to a lateral groin yammer - a hole in intra-painting fascia, through which the seed can be passed in men and a round bunch of uterus - in women)

The channel has 4 walls:

front - aponeurosis of the outer oblique muscle

rear - transverse (intraper) fascia

Upper - lower edges of the inner oblique and transverse abdominal muscle

Low - groove

Poor Channel (NO Norma)

Between the femoral vein and the lacunar bundle in vascular lacuna remains the gap (the femoral ring filled with a loose fiber through which femoral hernias come out. The hernial bag on the front surface of the hip passes between the surface and deep leaflets of the wide fascia, will break the lattice fascia and comes under the skin. As a result Pearling of the femoral hernia is formed a femoral canal.
The deep ring of the femoral channel corresponds to the femoral ring, which is limited: in front - a groove bunch; Behind - combed bond; Medial - lacunar bunch; Lateral - femoral vein.

The surface ring of the femoral channel corresponds to HIATUS SAPHENUS in a surface sheet of wide fascia, which is limited to a sickle edge.

The femoral canal has 3 walls:

Front - a surface sheet of wide fascia (upper horn of the crucible edge);

Outdoor - vagina of the femoral vein;

Rear - deep sheet of wide fascia (f. Pectinea).

Channel length from 1 to 3 cm.

Hernia - the yield of internal organs covered with parietal peritoneum, through weak places or artificial openings of the front-facing abdominal wall outside the abdominal cavity .

Hernia elements:

1. Herry gate - a gap or a hole in the abdominal wall, through which the organs of the abdominal cavity come;

2. Herry bag - formed by a parietal leaflet of peritoneum. It distinguishes: neck; body and bottom;

3. The contents of the hernial bag - the abdominal organ

Classification Gryzh

by the time of appearance and features of development:

- Acquired

- Congenital

localization:

- outdoor

- internal

at the place of release:

- Inguinal (oblique, straight)

- femoral

- Underground

- white belly lines

- Lumbar

- Sedalishche

- Cinema

- diaphragmal

Factors contributing to the occurrence of hernia:

1) the presence of "weak places" in the muscular-aponeurotic layer of the abdominal wall ("predisposing factor").

2) sharp increase in intra-abdominal pressure ("producing factor")

Inguinal herrozhi

Oblique. Herry Gate - Lateral Packing Pack

Straight. Herry Gate - Medial Packing Pack

Purchased. Herge bag - Parietal peritone. Egg has a vaginal shell

Congenital. Herge Bag - Needed Vaginal Abnortic Culture

Hergeless

The operation must be radical, simple and least traumatic

It consists of three stages:

1) access to the hernial goal and hernia bag;

2) processing and removing a hernia bag;

3) Elimination of the abdominal wall defect (closing the junk gate).

1st stage - Access

requirements:

Simplicity;

Security;

The possibility of a wide view of the hernial canal or hernia hole.

The condition of the tissues in the area of \u200b\u200bthe hernial gate should be taken into account (inflammation, scars).

2nd stage - Takes:

1. Careful release of the hernial bag from the surrounding tissues to the hernial gate (the "hydraulic preparation method", the introduction around the bag wall 0.25% of novocaine)

2. Opening the hernial bag in the bottom area and the rightness of hernia content

3. Firming and burning neck neck bags with its subsequent cutoff

3rd Stage: Methods Plastic Gate

1) simple;

2) reconstructive;

3) plastic.

Sterling - closure of the defect of the abdominal wall with the help of seams.

Reconstructive methods - change in the design of the hernial gate in order to strengthen them.

Plastic methods With large "solar" hernias, when its own fabrics are not enough (aponeurotic or muscle flaps on the feeding leg from nearby areas, synthetic material).

by Girarp (1).

a - bugging of the inner oblique and transverse abdominal muscles to the groin bond;

b - the tip of the top flap of the aponeurosis outer oblique abdominal muscle to the groove bunch;

B - the latch of the lower flap of the aponeurosis on the top.

on Spakokuksky

Simultaneous seams through the upper flap of the aponeurosis of the outer oblique abdominal muscles, transverse and inner oblique muscles and inguinal ligament ahead

Seed cake

Shov Kimbarovsky (2)

Plastic in the inguinal canal in Martynov (1) Bringing the internal flap of the aponeurosis of the outer oblique muscle of the abdomen to the groove bunch and outdoor on the inner

Plastic back wall

Bassini Patch Channel Plastic (2):

a - bugging of the inner oblique, transverse and direct abdominal muscles to the groove bunch behind the seed rope;

B - crosslinking of the internal and external flaps of the aponeurosis of the outer oblique abdominal muscle ahead of the seed rope.

Plastic on Pesmepsky (In the elderly, in the degros of the front abdominal wall)

Upper brace of aponeurosis of the outer oblique muscle and the inner oblique, the transverse muscles are laid behind the seed rope to the groove bundle, and the lower flap is applied to the top.

The rope is located under the skin.

Plastic with femoral hernias

With femoral access.

Bassini - the imposition of seams connecting the inguinal bunch with a comb (cooper) bundle.

When accessing through the groove channel.

According to Ruji - the ligament ligament to the comb (cooper) bundle on the side of the abdomen.

By Palavechcho - 1st series of seams: Launching of the groove bundle to comb (cooper) bond; 2nd series of seams: beaded the edges of the inner oblique and transverse muscles to the groove bundle behind the seed rope

Plastic with pusheny hernias and hernias of a white belly line

mEYO

a - bugging of the lower flap of the aponeurosis to the upper flap near the P-shaped seams;

Washing the top flap of the aponeurosis to the lower flap near the nodal seams

on sapezhko

a - the edge of the edge of the right flap of the aponeurosis to the rear wall of the vagina's left-handed abdominal muscles;

B - Loading the left flap of aponeurosis to the front wall of the vagina with the right straight abdominal muscle.

in Lexer

a - overlaying a brush seam around the umbilical ring;

B - the imposition of nodal seams on the front wall of the vagina of direct abdominal muscles.

Sliding hernia

The hernia bag is partially formed by the wall of the hollow organ, mesoperitoneally covered in peritoneum (bladder, blind intestine, less often Other organs)

Feature of operational equipment:

1. The hernia bag is widely opened in a distance from the organ;

2. Herge-glazed contents are eventually refilled and imposed from the inside of a hernial bag of brushless seam at the place of the transition of peritoneum to the organ;