The rectus muscle runs in the midline from xiphoid process to the pubic crest. The rectus muscle is surrounded by the rectus sheath, which consists of the aponeuroses of the oblique muscles and the transversus abdominis muscle. Pyramidalis is a small, triangular-shaped muscle which marks the midline and assists in the identification of the medial borders of the rectus muscle.
The linea alba consists of a band of dense, crisscross fibers of the aponeuroses of the abdominal muscles. It extends from the xiphoid to the pubic symphysis.
The retroperitoneum is bounded anteriorly by the peritoneum, and cranially by the diaphragm. The posterior border of the retroperitoneum is the abdominal wall which consists of the lumbodorsal fascia and sacrospinalis and quadratus lumborum muscles. The lateral boundary of retroperitoneum is the preperitoneal fat and transversus abdominis musculature of the lateral abdominal wall. Caudally the retroperitoneum is continuous with the extraperitoneal pelvic structures.
Thus, the layers encountered in a midline incision from superficial to deep are skin, subcutaneous tissue, superficial fascia, linea alba, transversalis fascia, extraperitoneal fat and peritoneum. The midline incision is easy and allows quick entry into the abdominal cavity but there is increased risk of wound dehiscence and hernia formation. On the other hand, oblique incision involves all the nine layers of the abdominal wall including skin, subcutaneous tissue, superficial fascia, external oblique muscle, internal oblique muscle, transversus abdominis muscle, transversalis fascia, preperitoneal adipose and areolar tissue, and peritoneum.
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