Vascular Anatomy and Variations of the Anterior Abdominal Wall – Significance in Abdominal Surgery

Abstract

Detailed knowledge of the human anatomy is an integral part of every surgical procedure. The majority of surgery related complications are due to a failure to possess appropriate knowledge of human anatomy. However, surgeons pay less attention of the anatomy of the anterior abdominal wall. It is composed of nine abdominal layers, which are composed of fascias, muscles, nerves, and vessels. Many superficial and deep vessels and their anastomoses supply the anterior abdominal wall. Moreover, anatomical variations of these vessels are often presented. Intraoperative and postoperative complications associated with entry and closure of the anterior abdominal wall could compromise the best surgical procedure. Therefore, sound knowledge of the vascular anatomy of the anterior abdominal wall is fundamental and a prerequisite to having a favourable quality of patient care. The purpose of the present article is to describe and delineate the vascular anatomy and variations of the anterior abdominal wall and its application in abdominal surgery. Consequently, the most types of abdominal incisions and laparoscopic accesses will be discussed. Furthermore, the possibility of vessels injury related to different types of incisions and accesses will be outlined in detail. Morphological characteristics and distribution pattern of the vascular system of the anterior abdominal wall is illustrated by using figures either from open surgery, different types of imaging modalities or embalmed cadaveric dissections. Oblique skin incisions in the upper or lower abdomen such as McBurney, Chevron and Kocher are not the topic of the present article.

Anatomical Variation of Abdominal Wall Musculature: An Objective Assessment Using Cross-Sectional Imaging

“…Mean width of the transversus abdominis aponeurosis from the lateral edge of rectus at P1 was −25.1 mm (IQR -37.8 mm to −15.0 mm, 10th centile −45.1 mm, 90th centile −2.9 mm) (negative results imply positive overlap of the transversus abdominis with the posterior sheath), at P2 was 29.4 mm (IQR 20 mm-39.8 mm, 10th centile 8.6 mm, 90th centile 57.3 mm), and at P3 was 20.3 mm (IQR 12 mm-29 mm, 10th centile 7.2 mm, 90th centile 35 mm) (Figure 6). anterior abdominal wall cutaneous innervation [12], in the distribution of preperitoneal fat [13], and in the vascular supply to the anterior abdominal wall [14]. We believe that this study is the first to use cross sectional imaging to interrogate the distribution of the abdominal wall muscles and to report their anatomical variation in detail.…”