The Autologous Pubovaginal Sling Supports the Proximal Urethra And
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Gross Anatomy ABDOMEN/SESSION 4 Dr. Firas M. Ghazi Posterior
Gross Anatomy ABDOMEN/SESSION 4 Dr. Firas M. Ghazi Posterior Abdominal Wall and the Diaphragm PAW : Posterior Abdominal Wall Curricular Objectives By the end of this session students are expected to: Practical 1. Identify the bones forming the PAW and their main markings 2. Distinguish the muscles forming the PAW and their fascial coverings 3. Trace the nerves of the PAW to their terminations 4. Identify the diaphragm and discriminate structures arising from its vertebral origin 5. Locate the major foramina of the diaphragm and the structures they transmit 6. Identify the retroperitoneal organs related to PAW Theory 1. State the framework of PAW 2. Name the bones forming the PAW and describe their main markings 3. Outline the muscles forming the PAW, their attachment and actions 4. Define the para-vertebral gutter and list the retroperitoneal organs related to it 5. Acknowledge the close relation of abdominal aorta to AAW 6. List the nerves related to PAW and their main distribution 7. Review the cremasteric reflex and acknowledge its physiological importance 8. Recall the patellar reflex and follow its pathway 9. Recall the attachment of the diaphragm and describe its vertebral origin 10. Underline the major foramina of the diaphragm and the structures they transmit 11. Review the innervation of diaphragm and the possible sites of referred pain 12. Summarize the fascial and peritoneal linings of the abdominal cavity Selected references and suggested resources Clinical Anatomy by Regions, Richard S. Snell, 9th edition Grant's Atlas of Anatomy, 13th Edition McMinn's Clinical Atlas of Human Anatomy, 7th Edition Anatomy for Babylon medical students (facebook page) Human Anatomy Education (facebook page) Human anatomy education (you tube channel) This session has been reviewed by Anatomy team at the Department of Anatomy and Histology/ College of Medicine/ University of Babylon/ 2016 Session check list Clinical importance Irritation of peritoneum on PAW can stimulate the related nerves and result in characteristic clinical manifestations. -
Bilateral Scarpa's Fascia Advancement Flaps to Improve The
Egypt, J. Plast. Reconstr. Surg., Vol. 35, No. 1, January: 133-140, 2011 Bilateral Scarpa’s Fascia Advancement Flaps to Improve the Waistline in Abdominoplasty WAEL M. ELSHAER, M.D.*; SAMEH ELNOAMANI, M.D.** and HOSSAM HOSNI, M.D.** The Department of Plastic and General surgery, Faculty of Medicine, Bani-Suef * and Cairo** Universities. ABSTRACT better sculpting or to hide the abdominal scar [1] . With the advent and popularity of the liposuction The goal of most abdominoplasty procedures is not only to improve the contour and shape of the abdomen, but to procedure and with a better understanding of skin achieve a smooth, flowing, harmonious contour by improving retraction post-liposuction surgery, many of the the overall silhouette and appearance of the region. The waist previously abdominoplasty procedures are now is an area of paramount importance for the feminine figure, treated by the less invasive and more rapid recovery which begins at the level of the lower ribs and ends at the procedure of liposuction surgery. Nevertheless, level of the iliac crest; its narrowest point is approximately 4cm above the navel. The purpose of this study was to report abdominoplasty still holds a very intricate and self- our results on 30 patients who underwent abdominoplasty satisfying place in the world of cosmetic surgery and improvement of the waistline utilizing Scarpa’s fascial [2] . The goal of most abdominoplasty procedures advancement flaps and plication in the midline. is not only to improve the contour and shape of the abdomen, but to achieve a smooth, flowing, Patients and Technique: During a 13-month period from January 2009 to February 2010 we operated on 30 patients. -
A Device to Measure Tensile Forces in the Deep Fascia of the Human Abdominal Wall
A Device to Measure Tensile Forces in the Deep Fascia of the Human Abdominal Wall Sponsored by Dr. Raymond Dunn of the University of Massachusetts Medical School A Major Qualifying Report Submitted to the Faculty Of the WORCESTER POLYTECHNIC INSTITUTE In partial fulfillment of the requirements for the Degree of Bachelor of Science By Olivia Doane _______________________ Claudia Lee _______________________ Meredith Saucier _______________________ April 18, 2013 Advisor: Professor Kristen Billiar _______________________ Co-Advisor: Dr. Raymond Dunn _______________________ Table of Contents Table of Figures ............................................................................................................................. iv List of Tables ................................................................................................................................. vi Authorship Page ............................................................................................................................ vii Acknowledgements ...................................................................................................................... viii Abstract .......................................................................................................................................... ix Chapter 1: Introduction ................................................................................................................... 1 Chapter 2: Literature Review ......................................................................................................... -
Anatomy and Physiology of the Abdominal Wall 0011 CHAPTER Internal Oblique Some Inferior fi Bers Form the Cremaster Muscle at the Level of the Inguinal Canal
Handbook of Complex Abdominal Wall Anatomy and physiology of the abdominal wall 0011 CHAPTER Álvaro Robín Valle de Lersundi, MD, PhD Arturo Cruz Cidoncha, MD, PhD 11.1..1. Anatomy of the abdominal wall 1.1.1. Introduction The abdominal wall is delimited by muscle structures than can be classifi ed in 5 ana- tomical areas: lateral, anterior, posterior, diaphragmatic and perineal (Table 1.1). We will describe the fi rst four due to their relevance in surgical repair of complex abdom- inal wall. These groups of muscles are enclosed by several bone structures: last ribs, chondrocostal joints, xyphoid, pelvis and costal apophysis of lumbar vertebrae. Layers of the anterior and lateral abdominal wall include skin, subcutaneous tissue, super- fi cial fascia, deep fascia, muscles, extraperitoneal fascia and peritoneum. Table 1.1. Muscular limits of the abdominal wall ∙ Quadratus lumborum POSTERIOR ∙ Psoas ∙ Iliac muscle ∙ External oblique LATERAL ∙ Internal oblique ∙ Transversus abdominis ∙ Rectus abdominis ANTERIOR ∙ Piramidalis CONTENTS SUPERIOR ∙ Diaphragm 1.1. Anatomy of the abdominal INFERIOR ∙ Perineal muscles wall 1.1.2. Muscles of the abdominal wall 1.2. Physiologyygy Muscles of the anterolateral wall Rectus abdominis The rectus abdominis (m. rectus abdominis) is a long and thick muscle that is extended from the anterolateral thorax to the pubis close to the midline (Figure 1.1). 1 Figure External oblique 1.1. Rectus abdominis The external oblique muscle (m. obliquus externus abdominis) is the most superfi cial and thickest of the three lateral abdominal wall muscles (Figure 1.2). Figure 1.2. External oblique muscle Handbook of Complex Abdominal Wall Handbook of Complex Cranially, the rectus abdominis muscles originates from 3 dig- itations that insert on the 5th-7th costal cartilages, the xyphoid process and costoxyphoid ligament. -
Rectus Abdominis Flap Technique for Head and Neck Reconstruction
OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY RECTUS ABDOMINIS FLAP FOR HEAD & NECK RECONSTRUCTION Patrik Pipkorn, Brian Nussenbaum The rectus abdominis flap is based on the Surgical anatomy deep inferior epigastric artery. It is a com- posite flap and comprises muscle, over- Rectus sheath (Figures 1-5) lying fascia and skin. It is versatile and provides a large volume of soft tissue and The rectus sheath is an aponeurosis arising is technically straightforward to raise. from the external oblique, internal oblique Many variations based on the inferior epi- and transversus abdominis muscles (Figure gastric artery, including perforator flaps, 1). It encircles the paired rectus muscles. have been described. The anterior and posterior rectus sheaths merge in the midline to form the linea alba In the head and neck it is typically used to that separates the paired rectus muscles reconstruct large oral defects, skull base (Figure 1). defects, maxillectomy defects or whenever a large volume of soft tissue is required. In the head and neck it has more recently been largely supplanted by the antero- lateral thigh free flap. Benefits of the rectus flap include • Technically straightforward and quick to harvest • Constant anatomy with anatomic varia- tions being rare • Harvesting in a supine position makes a two-team approach feasible • Provides the largest volume of soft tis- sue based on a single pedicle • Long pedicle and 2-4mm diameter Figure 1: Anterior abdominal wall artery crossectional anatomy and arcuate line • Reliable perforators that do not need to be dissected or visualised When harvesting a rectus flap, the anterior • Low donor site morbidity rectus sheath is incised vertically over the midportion of the rectus muscle, whereas Caveats include the posterior sheath is preserved. -
Diastasis Recti Abdominus Association Spring Conference 2018
Diagnosis and treatment of DRA. 4/13/18 MPTA Spring Conference 2018. Kansas City Jennifer Cumming, PT, MSPT, Diagnosis and treatment of CLT, WCS Missouri Physical Therapy No disclosures Diastasis Recti Abdominus Association Spring Conference 2018 Objective Case study #1 complaints 1. Understand anatomy of abdominal wall and deep motor control • Mrs. H is 37 year old who is 6 months post-partum system • Back pain since late pregnancy and postpartum period. 2. Understand the causes and prevalence of diastasis rectus • Pain not responding to traditional physical therapy abdominus (DRA) • Pain with transition movements and bending 3. Understand how to assess for DRA • Also c/o stress urinary incontinence and pain with intercourse 4. Understand basic treatment strategies for improving functionality of abdominal wall and deep motor control system Case study #1 orthopedic assessment Case study #2 complaints • 1 ½ finger diastasis rectus abdominus just inferior to umbilicus • Ms. S is a 20 year old elite college level athlete • Active straight leg raise (ASLR) with best correction at PSIS indicating • History of DRA developing with high level athletic training involvement of posterior deep motor control system • Complains of LBP with prolonged sitting, bending, and lifting activities • L3 right rotation at level of DRA • Hypertonicity B internal oblique muscles Property of J Cumming, PT, MSPT, CLT, WCS. Do not copy without permission. 1 Diagnosis and treatment of DRA. 4/13/18 MPTA Spring Conference 2018. Kansas City Case study #2 orthopedic assessment -
Transcatheter Arterial Embolization of Spontaneous Soft Tissue Hematomas: a Systematic Review
Cardiovasc Intervent Radiol (2019) 42:335–343 https://doi.org/10.1007/s00270-018-2086-x CLINICAL INVESTIGATION ARTERIAL INTERVENTIONS Transcatheter Arterial Embolization of Spontaneous Soft Tissue Hematomas: A Systematic Review 1 2,3 1,4 1 Lahoud Touma • Sarah Cohen • Christophe Cassinotto • Caroline Reinhold • 5 1 1 1 1 Alan Barkun • Vi Thuy Tran • Olivier Banon • David Valenti • Benoit Gallix • Anthony Dohan1,6 Received: 5 June 2018 / Accepted: 28 September 2018 / Published online: 11 October 2018 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018 Abstract surgical management were excluded. For each publication, Background Severe spontaneous soft tissue hematomas clinical success based on the control of the bleed, (SSTH) are usually treated with transcatheter arterial rebleeding rates and complications (including mortality) embolization (TAE) although only limited retrospective was collected, as well as technical details. studies exist evaluating this treatment option. The aim of Results Sixty-three studies met the inclusion criteria, with this study was to systematically assess the efficacy and an aggregate total of 267 patients. Follow-up extended safety of TAE for the management of SSTH. from 1 day to 10 years. Bleeding was mainly localized to Methods Medline, EMBASE, PubMed and Cochrane the iliopsoas (n = 113/267, 42.3%) and anterior abdominal Library were searched from inception to July 2017 using wall (n = 145/266, 54.7%). When information was avail- MeSH headings and a combination of keywords. Eligibility able, 81.0% (n = 158/195) of patients were on anticoagu- was restricted to original studies with patients suffering lant therapy prior to the bleeding episode. -
The Anatomy and Pathophysiology of the CORE
Robert A. Donatelli The Anatomy and Pathophysiology of the CORE LEARNING OBJECTIVES design a rehabilitation program to promote an increase in After studying this lesson, the reader will be able to do the strength, power, and endurance specific to the muscles and following: joints that are in a state of dysfunction. Specificity of the reha- 1. Define the hip and trunk CORE bilitation program can help the athlete overcome muscu- 2. Evaluate the CORE muscles and structure loskeletal system deficits and achieve maximum potentials of 3. Delineate the difference between local and global muscles his or her talents. A combination of power, strength, and on the back endurance is critical for the muscles of the CORE to allow the 4. Identify the muscles of the abdominal area that are con- athlete to perform at his or her maximum capabilities. sidered stabilizing The lower quadrant CORE is identified by the muscles, 5. Identify the spinal muscles that stiffen the spine ligaments, and fascia that produce a synchronous motion and 6. Evaluate the CORE dysfunction stability of the trunk, hip, and lower extremities. The initia- 7. Instruct patients in exercises designed to strength hip and tion of movement in the lower limb is a result of activation of trunk muscles certain muscles that hold onto bone, referred to as stabilizers, 8. Identify the correlation between muscle weakness in the and other muscles that move bone, referred to as mobilizers. The hip and lower extremity injuries muscle action within the CORE depends on a balanced activity of the stabilizers and mobilizers. If the stabilizers do not hold onto the bone, the mobilizing muscles will function at a dis- INTRODUCTION AND DEFINITION advantage. -
Hernias of the Abdominal Wall: Inguinal Anatomy in the Male
Hernias of the Abdominal Wall: Inguinal Anatomy in the Male Bob Caruthers. CST. PhD The surgical repair of an inguinal hernia, although one of the in this discussion. The anterolateral group consists of two mus- most common of surgical procedures, presents a special chal- cle groups whose bodies are near the midline and whose fibers lenge: Groin anatomy remains one of the more difficult topics are oriented vertically in the standing human: the rectus abdo- to master for both the entry-level student and the first assistant. minis and the pyramidalis. The muscle bodies of the other This article reviews the relevant anatomy of the male groin. three groups are more lateral, have significantly larger aponeu- roses, and have obliquely oriented fibers. These three groups MAJOR FASClAL AND UGAMENTAL STRUCTURES contribute the major portion of the fascia1 and ligamental The abdominal wall contains muscle groups representing two structures in the groin area.',!.' broad areas: anterolateral and posterior (see Figure 1).The At the level of the inguinal canal, the layers of the abdomi- posterior muscles, the quadratus lumborum, do not concern us nal wall include skin, subcutaneous tissue (Camper's and aponeurosis (cut edge) Internal abdominal (cut and turned down) Lacunar (Gimbernatk) ligament Inguinal (Poupart k) 11ganenr Cremaster muscle (medial origin) Cremaster muscle [lateral origin) Falx inguinalis [conjoined tendon) Cremaster muscle and fascia Reflected inguinal ligament External spermatic fascia (cut) Figun, 1-Dissection of rhe anterior ahdominal wall. Rectus sheath (posterior layerl , Inferior epigastric vessels Deep inguinal ring , Transversalis fascia (cut away) '.,."" -- Rectus abdomlnls muscle \ Antenor-supenor 111acspme \ -. ,lliopsoas muscle Hesselbach'sl triangle inguinalis (conjoined) , Tesricular vessels and genital branch of genitofmoral Scarpa's fascia), external oblique fascia, from the upper six ribs course downward inguinal (Poupart's) ligament. -
1 Anatomy of the Abdominal Wall 1
Chapter 1 Anatomy of the Abdominal Wall 1 Orhan E. Arslan 1.1 Introduction The abdominal wall encompasses an area of the body boundedsuperiorlybythexiphoidprocessandcostal arch, and inferiorly by the inguinal ligament, pubic bones and the iliac crest. Epigastrium Visualization, palpation, percussion, and ausculta- Right Left tion of the anterolateral abdominal wall may reveal ab- hypochondriac hypochondriac normalities associated with abdominal organs, such as Transpyloric T12 Plane the liver, spleen, stomach, abdominal aorta, pancreas L1 and appendix, as well as thoracic and pelvic organs. L2 Right L3 Left Visible or palpable deformities such as swelling and Subcostal Lumbar (Lateral) Lumbar (Lateral) scars, pain and tenderness may reflect disease process- Plane L4 L5 es in the abdominal cavity or elsewhere. Pleural irrita- Intertuber- Left tion as a result of pleurisy or dislocation of the ribs may cular Iliac (inguinal) Plane result in pain that radiates to the anterior abdomen. Hypogastrium Pain from a diseased abdominal organ may refer to the Right Umbilical Iliac (inguinal) Region anterolateral abdomen and other parts of the body, e.g., cholecystitis produces pain in the shoulder area as well as the right hypochondriac region. The abdominal wall Fig. 1.1. Various regions of the anterior abdominal wall should be suspected as the source of the pain in indi- viduals who exhibit chronic and unremitting pain with minimal or no relationship to gastrointestinal func- the lower border of the first lumbar vertebra. The sub- tion, but which shows variation with changes of pos- costal plane that passes across the costal margins and ture [1]. This is also true when the anterior abdominal the upper border of the third lumbar vertebra may be wall tenderness is unchanged or exacerbated upon con- used instead of the transpyloric plane. -
Transversus Abdominis Muscle Release: Technique, Indication, and Results Wolfgang Reinpold
[Downloaded free from http://www.herniasurgeryjournal.org on Monday, November 4, 2019, IP: 10.232.74.26] Review Article Access this article online Quick Response Code: Transversus abdominis muscle release: Technique, indication, and results Wolfgang Reinpold Website: Abstract: www.herniasurgeryjournal.org Component separation technique (CST) allows the mobilization of large musculofascial flaps of the abdominal wall and was developed for the treatment of very large, primary and incisional abdominal DOI: 10.4103/ijawhs.ijawhs_27_18 wall hernias. The classic open anterior CST first published by Albanese and later by Ramirez is associated with high complication rates. According to a recent literature review, CST without mesh should no longer be performed because of high recurrence rates. Classic anterior CST is associated with high rates of surgical-site occurrences and infections and should only be performed as endoscopic- and perforator-sparing anterior CST. The unfavorable results of classic CST resulted in the development of numerous new anterior and posterior CST modifications, several of them were minimally invasive. The posterior CST with transversus abdominis muscle (TAM) release (TAR) published by Novitsky et al. is an extension of the original retrorectus Rives operation and Stoppa procedure. The technique avoids vast skin flaps and allows the closure of large abdominal wall defects and insertion of very large retromuscular alloplastic standard sublay meshes without damaging the vessels and intercostal nerves. The TAR procedure is one of the major advances of abdominal wall surgery of the last decades. Several new promising minimally invasive modifications including robotic-assisted TAR have been published recently. The indications and technique of the TAM (TAR) procedure and its minimally invasive modifications are described. -
Abdominal Wall Repair Guide
Procedure Guide for Surgeons A Revolutionary Approach to Soft Tissue Support and Repair in Abdominal Wall Surgery The First and Only Silk-Derived Biological Scaold i TABLE OF CONTENTS 1-3 SECTION 1: Introduction and Overview Indications and Important Safety Information 4 SECTION 2: Guiding Principles 5 SECTION 3: Procedural Steps Pre-Op Checklist Product Preparation and Surgical Recommendations • Device Properties and Orientation • Suturing • Drains • Postoperative Management 10 SECTION 4: Step-by-Step Guides for 3 Surgical Procedures Overlay Placement With or Without Concurrent Hernia Repair Retrorectus Placement Ventral Hernia Repair Inlay or Overlay Placement TRAM and DIEP Donor Site Reinforcement 26 SECTION 5: Clinical Case Studies Abdominoplasty by Max R. Lehfeldt (Pasadena, CA) Ventral Hernia Repair by Mark W. Clemens (Houston, TX) TRAM Reinforcement by Mark W. Clemens (Houston, TX) 33 REFERENCES ii SERI® Surgical Scaffold: Indications and Important Safety Information1 Indications for Use SECTION 1: SERI® Surgical Scaffold is indicated for use as a transitory scaffold for soft tissue support Introduction and and repair to reinforce deficiencies where weakness or voids exist that require the addition of material to obtain the desired surgical outcome. This includes reinforcement of soft Overview tissue in plastic and reconstructive surgery, and general soft tissue reconstruction. Important Safety Information Contraindications SERI® Surgical Scaffold is a knitted, multifilament • Patients with a known allergy to silk • Contraindicated for direct contact with bowel or viscera where formation of long-term bioresorbable scaffold made entirely of silk adhesions may occur protein. It is derived from silk that is highly purified to Precautions yield ultrapure fibroin. The device is a mechanically • SERI® Surgical Scaffold should be stored in a dry area in its original sealed package strong and biocompatible protein mesh.