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Abdomen Abdominal Aorta, Anatomy, 631–632 Abdominal Aortic

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Index Abdomen anal fi stulectomy, 478 abdominal aorta, anatomy, 631–632 fi stulous tract, probe and abdominal aortic aneurysm repair incision, 481 elective infrarenal, 641–644 Goodsall-Salmon’s rule of abdominal hysterectomy fi stulas, 482–483 bilateral salpingo- seton procedure, 481 oophorectomy, 658 anorectal landmarks, 476 incision, surgical technique, band ligation 655–662 anus examination and prolapse abdominal incisions, 148 reduction, 490–493 midline, thoracic extension McGivney and McGowan band of, 150 ligator, 489 anterior abdominal wall, 113–115 digital examination, 477–478 blood supply of, 131–132 external thrombosed fossae of, 117–118 hemorrhoids, incision hernias, see Hernia and drainage of, 489 layers of, 117 hemorrhoidectomy supply of, 132–134 external hemorrhoid, 483 Adrenal glands ischiorectal abscess, 478, 480 adrenalectomies, 607–618 pilonidal cyst, excision of, laparoscopic adrenalectomy, 493–495 619–630 sigmoidoscopic examination, relations of, 603–604 475–476, 479 right and left, 604 stapled hemorrhoidectomy vascular system of, 605–606 open-sided retractor, 486–487 Anal canal and perianal regions, sigmoidoscopy, 487–489 surgical procedures Anterior iliopubic tract repair, anal fi ssure, 483 condon procedure, 175 668585 686 Index Anus and rectum vascular system of lymph drainage of, 437 arterial supply, 96 pelvic splanchnic nerves, venous drainage, 100 436–437 Buccopharyngeal fascia, 28 Aponeurosis conjoined area, 121–122 Carotid endarterectomy, 631, inguinal canal, 127 635–640 inguinal ligament, 119 anatomy for, 631 lacunar and pectineal ligament, 120 Carotid triangle, 23 Appendix Carpal tunnel appendectomy, 406–411 canals within, 669 laparoscopic appendectomy, distal, central and upper proximal 412–413 zone divisions, 672 relations and positions of, 403 median nerve vascular system of, 403 anatomical variations of, 674 blood and venous supply, 404 motor branches topography lymphatic drainage, 404–405 of, 668 Arteria thyroidea ima, 35 palmar cutaneous Auriculotemporal nerve, 46 branches of, 671 Axilla, 95 presentation of surgical anatomy lymph nodes of, 101 and, 665–667 topography of, 96 proximal surgical and distal surgical zone, 670 Biliary tract anatomy, 533 surgical treatment of, 673 Body wall lower anterior, 117–118 volar carpal ligament, division posterior (lumbar), 145–146 of, 676 Bogros, space deep inguinal Cavitron ultrasonic aspirator vasculature, 138 (CUSA), 524 Branchial cleft sinuses and cysts Cecopexy, colon, 438–439 excision of, 76–78 Cecostomy, colon, 438 remnants anatomy Choledochal cystectomy, 565–566 cysts, 49–51 Choledochoduodenostomy, 560–564 fi stulas, 47–48 Circle of death, 145 sinuses, 48–49 Colles fascia, 118, 122 Breast Colon anatomy cecum, 415 axilla, 95 ileocecal folds, 416 deep pectoral fascia, 93–95 colon proper muscles and nerves, 95 Jackson’s veil, 416, 418 sagittal section, 99 mesocolon, 416 lymphatic drainage, 100–102 mobile cecum, 417 and mastectomy, 97–100 right colon, attachment degrees, morphology of, 95–96 417 Index 687 sigmoid mesocolon, average Copious lymphorrhea, 32 measurements, 419 Cysts, 49 transverse, 418 incomplete closure of 2nd fascial relations and tissue branchial cleft/ pouch, 50 spaces, 425 layers of wall Direct inguinal hernia anal canal, 421, 423 condon repair of, 175 anus and rectum, spaces of, 422 nyhus procedure, 188–189 epiploic appendages, 420 repair of, 174 external anal sphincter loops, 423 Douglas linea semicircularis, 115 rectum, 421 sphincteric elements, 422 Epigastric artery, 131 transverse colon, 421 rectus sheath, 132 lymphatic drainage of Epigastric hernia, 160–162. See also divisions, 431–432 Linea alba pelvic diaphragm and continence External supravesical hernias, 179 fasciae of, 426 possible pathways of, 136 muscles, 425 Extrahepatic biliary tract rectum and anal canal, 418 cholecystectomy, 545–548 resection choledochal cystectomy, 565–566 abdominoperineal, 463–465 choledochoduodenostomy, left colectomy, 453 560–564 preoperative preparation, 447 common bile duct, 536–538 right colectomy, steps, exploration, 551–560 447–452 cystic duct, 535 triple-staple procedure, low gallbladder, 535–536 anterior, 453–459 hepatocystic triangle and triangle surgery, decalogue, 438 of calot, 538–541 vascular system operative cholangiogram, marginal and inferior 549–551 mesenteric artery, 428 sphincteroplasty, 560 middle colic artery, 428 vascular system of, 541–542 right colon, arteries variations, 429 venous and lymphatic drainage, superior mesenteric artery, 543–544 427–428 Extraperitoneal laparoscopic inguinal Colostomy herniorrhaphy end colostomy, 442, 464 operating room set-up, 198 loop colostomy, 439–447 Prasad end loop colostomy, 444 Facial artery, 20 Condon repairs, 175 Facial nerve trunk, 46–47 Conjoined area, 121 Falx inguinalis, 117, 122 Cooper ligament repair Femoral artery relaxing incision, 178–179 superfi cial branches of, 131 688 Index Femoral canal, 130–131 Lichtenstein repair, 201–202 Femoral hernia, 179–181 Nyhus procedure, 186–189 abdominal wall and hernias, preperitoneal approach, 186–187 184–185 superfi cial fascia, 118–119 Nyhus procedure for, 188–189 repair above inguinal ligament, Harmonic Scalpel, 468 181–182 Henle ligament, 117, 122 repair below inguinal ligament, Hepatic duct and subvesicular bile 183–185 ducts, 533–535 Femoral sheath, 137 Hernias. See also Groin hernias. Femoropopliteal bypass, 644–651 anterior abdominal wall Fistulas, 47 incisions of, 148–154 congenital cervicoaural, 48 Bard plug and patch repair, 204–207 track of 2nd-pouch and-cleft, 49 Body wall, lower anterior, Flexor retinaculum 117–118 division of, 676 Bogros space of, 123–124 postage stamp size, 668 direct inguinal superfi cial relations of, 669 Condon repair of, 175 Fossae of the abdominal wall repair of, 174 lateral, medial, 118 epigastric hernia, 160, 162 supravesical, 118–119 external supravesical hernia, 179 Frey’s syndrome, 46 femoral hermia. See Femoral Fruchaud’s myopectineal orifi ce Hernia. Gillert sutureless anterior view, 129 mesh-plug repair, 202–203 posterior view of, 139 groin, Cooper ligament repair, and mesh coverage, 195 168–172 Full-thickness skin graft, 11 incisional hernia smaill defects, 156–157 Gel Port, 470–471, 473–474 indirect inguinal Giant prosthetic reinforcement of Condon repair of, 175 visceral sac (GPRVS) Cooper ligament repair, (GPRVS), Stoppa procedure, 193 168–172 Gilbert sutureless, mesh-plug repair, Shouldice technique in, 202–203 176–178 Gimbernat. See Lacunar ligament inguinal, iliopubic tract repair Great auricular nerve, 46 and, 187 Groin hernias, 168–172. See also Kugel repair, 157–160 Hernias. Shouldice technique, 176–178 anatomy of, 118–131 sliding indirect inguinal repair of, ihopulric tract repair of, 127 172–174 indirect inguinal hernia spigelian, 163–166 Cooper ligament repair of, repair of, 167 168–172 umbilical laparoscopic approach, 194–200 Hesselbach triangle, 126 Index 689 Horner’s syndrome, 41 Interfoveolar ligament, 122 Hydrocele Internal thoracic artery, 99 adult noncommunicating repair of, 208–209 Kugel hernia repair, 189–193 Hypoglossal nerve (XII), 21 Lacunar ligament, 120 Ileoanal anastomosis/restorative Laparoscopic adrenalectomy, proctocolectomy and 619–630 GIA insertion, 460, 462 Laparoscopic appendectomy, J-pouch construction, 461 appendix, 412–413 pouch apex, anastomosed, 462 Laparoscopic cadaveric typical proctocolectomy, panorama, 135–145 460–461 Laparoscopic cholecystectomy, Iliopectineal arch, 125 566–572 Iliopubic tract, 122–123 Laparoscopic colectomy diagrammatic presentation hand-assisted, 465–466 of, 142 left, 470–473 Incisional hernias, 155–160 right, 473–475 Incisions sigmoid, 467–470 dehiscence of, 154 total abdominal, 475 lower midline incision, 151 Laparoscopic Nissen fundoplication, pararectus incision, 152 238–243 surgical anatomy of, 148–149 Laparoscopic splenectomy, 593–601 upper midline, 149–150 Left colectomy, 463–465 Indirect inguinal hernia left ureter, identifi cation, 454 Condon repair of, 175 ligament division, 453 Nyhus procedure, 188–189 Levator ani muscles, 425–426 Inguinal canal puborectalis, 427 anterior, inferior and posterior Lichtenstein herniorrhaphy, 201–202 wall, 127 Linea alba, 115, 160–162 in female, 127–128 incisions of, 149–150 in male, 126–127 Liver wall, posterior “strong,” “weak,” excisional biopsy, 517, 518 128 hepatic artery, 505–508 Inguinal hernia. See Groin hernias. hepatic resections, 519–520 Inguinal ligament, 119 hepatic veins, 510–511 Inguinal region intrahepatic duct system, 502–504 deep inguinal vasculature, 138 left hepatic lobectomy, 521–524 laparoscopic topographic anatomy left lateral segmentectomy, 522 of, 136 falciform ligament, 525 Inguinal ring left lobe, diminished size, 504 superior and inferior crura form, lobectomy and segmentectomy, 126 planes of transection, 521 Innominate fascia, 117 lymphatic drainage, 511–512 690 Index morphology, 501–502 thyroid gland, 27 true lobulation and fasciae, superfi cial and deep, segmentation, 501 25–28 needle biopsy, 517 lymphatics of, 28–30 perihepatic spaces, 513–516 lymph nodes and lymphatic peritoneal refl ections and drainage of head and neck, ligaments, 498–500 29–30 portal vein, 508–509 nonthyroid neck masses resection and trauma, 527–531 rule of 80 and 7, 52 right hepatic lobectomy, posterior cervical triangle, 525–529 23–24 topographic anatomy, 497–499 radical neck dissection, 78 Loop colostomy, 439–447 anatomy, 80–88 Lower extremity bypass anatomy, synopsis of, 79 631–634 spaces in, 28 Lumbar hernia (Dowd-Ponka) repair, sternocleidomastoid muscle, 26 209–211 Nyhus hernia repairs,
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    Van De Graaff: Human IV. Support and Movement 10. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Surface and Regional 10 Anatomy Introduction to Surface Anatomy 297 Surface Anatomy of the Newborn 298 Head 300 Neck 306 Trunk 309 Pelvis and Perineum 318 Shoulder and Upper Extremity 319 Buttock and Lower Extremity 326 CLINICAL CONSIDERATIONS 330 Clinical Case Study Answer 339 Chapter Summary 340 Review Activities 341 Clinical Case Study A 27-year-old female is brought to the emergency room following a motor vehicle accident. You examine the patient and find her to be alert but pale and sweaty, with breathing that is rapid and shallow. You see that she has distension of her right internal jugular vein visible to the jaw and neck. Her trachea is deviated 3 cm to the right of midline. She has tender contu- sions on her left anterior chest wall with minimal active bleeding over one of the ribs. During the brief period of your examination, the patient exhibits more respiratory distress, and her blood pressure begins to drop. You urgently insert a large-gauge needle into her left hemitho- rax and withdraw 20 cc of air. This results in immediate improvement in the patient’s breath- ing and blood pressure. Why does the patient have a distended internal jugular vein on the right side of her neck? Could this be related to a rapid drop in blood pressure? What is the clinical situation of this patient? Hint: As you read this chapter, note that knowledge of normal surface anatomy is vital to the FIGURE: In order to effectively administer medical treatment, it is imperative for a recognition of abnormal surface anatomy, and that the latter may be an easy clue to the pathol- physician to know the surface anatomy of each ogy lying deep within the body.
  • 432 Surgery Team Leaders

    432 Surgery Team Leaders

    3 Common Neck Swellings Done By: Reviewed By: Othman.T.AlMutairi Ghadah Alharbi COLOR GUIDE: • Females' Notes • Males' Notes • Important • Additional Outlines Common Anatomy of the Neck Neck Ranula Swellings Dermoid cyst Thyroglossal cyst Branchial cysts Laryngocele Carotid body tumor Hemangioma Cystic Hygroma Inflammatory lymphadenopathy Malignant lymphadenopathy Thyroid related abnormalities Submandibular gland related abnormalities Sjogren's syndrome 1 Anatomy of the Neck: Quadrangular area (1): A quadrangular area can be delineated on the side of the neck. This area is subdivided by an obliquely prominent sternocleidomastoid muscle into anterior and posterior cervical triangles. Anterior cervical triangle is subdivided into four smaller triangles: -Submandibular triangle: Contains the submandibular salivary gland, hypoglossal nerve, mylohyiod muscle, and facial nerve. -Carotid triangle: Contains the carotid arteries and branches, internal jugular vein, and vagus nerve. -Omotracheal triangle: Includes the infrahyoid musculature and thyroid glands with the parathyroid glands. -Submental triangle: Beneath the chin. Figure 1: Anterior cervical muscles. 2 Posterior cervical triangle: The inferior belly of the omohyoid divides it into two triangles: -Occipital triangle: The contents include the accessory nerve, supraclavicular nerves, and upper brachial plexus. -Subclavian triangle: The contents include the supraclavicular nerves, Subclavian vessels, brachial plexus, suprascapular vessels, transverse cervical vessels, external jugular vein, and the nerve to the Subclavian muscle. The main arteries in the neck are the common carotids arising differently, one on each side. On the right, the common carotid arises at the bifurcation of the brachiocephalic trunk behind the sternoclavicular joint; on the left, it arises from the highest point on arch of the aorta in the chest.