The incision for this procedure is made in the abdominal wall. Thus, many different layers of the abdominal wall are cut in order to make the incision. In order to understand the incisional anatomy, it is important to have a good knowledge about the anatomy of the abdominal wall. There are nine layers in the abdominal wall: skin, subcutaneous tissue, superficial fascia, external oblique muscle, internal oblique muscle, transversus abdominis muscle, transversalis fascia, preperitoneal adipose and areolar tissue, and peritoneum.
The subcutaneous tissue comprises of Camper’s fascia and Scarpa’s fascia. Camper’s fascia is the outer layer and contains subcutaneous fat; Scarpa’s fascia is the inner, dense layer of fibrous connective tissue. Scarpa’s fascia helps in the alignment of the skin after abdominal incision.
The external oblique muscle is the most superficial muscle of the abdominal wall. It arises from the lower 8 ribs and runs transversely in a superolateral to inferomedial direction to insert into the anterior half of iliac crests. The muscles form the aponeurosis (a strong tendinous sheat) in the midclavicular line that passes anteriorly to the rectus sheath to attach medially into the linea alba.
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