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1、CHAPTER45ABDOMINALWALL,UMBILICUS,PERITONEUM,MESENTERIES,OMENTUM,ANDRETROPERITONEUMRichardH.TurnageandBrianBadgwellAnatomyabdominalwallandumbilicusThereareninelayerstotheabdominalwall—skin,subcutaneousperitoneumandperitonealcavitytissue,superficialfascia,externalobliquemuscle,internalmesenteryand
2、omentumobliquemuscle,transversusabdominismuscle,transversalisretroperitoneumfascia,preperitonealadiposeandareolartissue,andperitoneum(Fig.45-1).ABDOMINALWALLANDUMBILICUSSubcutaneousTissuesThesubcutaneoustissueconsistsofCamper’sandScarpa’sfascia.EmbryologyCamper’sfasciaisthemoresuperficialadipose
3、layerthatcontainsTheabdominalwallbeginstodevelopintheearlieststagesofthebulkofthesubcutaneousfat,whereasScarpa’sfasciaisaembryonicdifferentiationfromthelateralplateoftheembry-deeperdenserlayeroffibrousconnectivetissuecontiguouswithonicmesoderm.Atthisstage,theembryoconsistsofthreethefascialataoft
4、hethigh.ApproximationofScarpa’sfasciaaidsprincipallayers—anouterprotectivelayertermedtheectoderm,inthealignmentoftheskinaftersurgicalincisionsintheloweraninnernutritivelayer,theendoderm,andthemesoderm.abdomen.Themesodermbecomesdividedbycleftsoneachsideofthelateralplate,whichultimatelydevelopinto
5、somaticandMuscleandInvestingFasciassplanchniclayers.Thesplanchniclayerwithitsunderlyingendo-Themusclesoftheanterolateralabdominalwallincludethedermcontributestotheformationoftheviscerabydifferentiat-externalandinternalobliqueandtransversusabdominis.Theseingintomuscle,bloodvessels,lymphatics,andc
6、onnectiveflatmusclesenclosemuchofthecircumferenceofthetorsoandtissuesofthealimentarytract.Thesomaticlayercontributestogiveriseanteriorlytoabroadflataponeurosisinvestingtherectusthedevelopmentoftheabdominalwall.Proliferationofmeso-abdominismuscles,termedtherectussheath.Theexternalobliquedermalcel
7、lsintheembryonicabdominalwallresultsinthemusclesarethelargestandthickestoftheflatabdominalwallformationofaninvertedU-shapedtubethatinitsearlystagesmuscles.Theyoriginatefromthelowersevenribsandcourseincommunicatesfreelywithth
