腹壁及腹腔探察.pptVIP

Dissection of Anterior Abdominal Wall With the cadaver in the supine position, incise the skin in the midline from the xiphisternal joint to the pubic symphysis, cutting around the umbilicus. Then incise the skin 1 inch above the pubis symphysis laterally over to and a little above the iliac crest to the midaxillary line on both sides. Reflect the skin from the midline anteriorlly to the midaxillary line, leaving the superficial fascia on the anterior abdominal wall. Identify the fatty layer of the superficial fascia ( Campers fascia)and note that it is continuous below with the fatty superficial fascia of the thigh and above with the superficial fascia of the thorax. Note that the fat is greatest in amount over the inferior half of the abdomen. Note also the terminal portion of the superficial arteries and cutaneous nerves in this layer; also observe the superficial veins. Identify the Membranous Layer of the Superficial Fascia (Scarpas Fascia). Note That It Lies Deep to the Fatty Layer and Immediately Superficial to the aponeurosis of the External Oblique Muscle. Insert a Finger Between the Membranous Layer and the aponeurosis of the External Oblique and Separate Them Inferiorly. Note That the Finger Can Be Passed Down Medial to the Pubic Tubercle Along the Spermatic Cord and Anterior to the Body of the Pubis Into the Perineum.Lateral to the Pubic Tubercle the Finger Cannot Enter the Thigh, However,since the Membranous Layer Is Attached to the Deep Fascia of the Thigh Just Below the Inguinal Ligament. Identify the Superficial Inguinal Ring Above the Pubic Tubercle but Do Not Disturb It at This Stage. The Ring Is a Triangular Opening in the aponeurosis of the External Oblique Muscle. Make a vertical incising through the full thichness of the superficial fascia from the xiphoid process to the symphysis pubis. With the aid of a scalpel handle, carefully reflect the flaps of fascia laterally, separating the fascia from the aponeurosis of the external oblique muscle.