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Anatomy of the Anterior Abdominal Wall
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
The nerve supply to the abdominal wall is carried in the anterior rami of the 5th–12th thoracic and the 1st lumbar spinal nerves. The 5th to the 11th thoracic spinal nerves pass out of the spinal canal through the intervertebral foramina below the corresponding thoracic vertebra and can be seen just deep to the pleura halfway along the neck of the rib. Here they give a branch to the sympathetic chain, the white rami communicantes, and split into the anterior and posterior rami. The anterior ramus (intercostal nerves for T5–T11, and subcostal nerve T12) carries the fibres for the abdominal wall, and these are joined by the intercostal artery, which runs immediately above the nerve, and the vein, which runs between the artery and the shaft of the rib. The neurovascular bundle closely follows the shaft of the rib and, at the posterior border of the innermost intercostal muscle, passes into the tissue plane between the innermost and internal intercostal muscles. At approximately the position of the anterior axillary line, the intercostal nerves give a lateral cutaneous branch which pierces the internal and external intercostal muscles and passes between the origins of external oblique to enter the dermis. These lateral cutaneous branches provide dermatomal sensation from the lateral border of the erector spinae muscle posteriorly to the lateral border of the rectus sheath anteriorly. Throughout the length of the nerves, small motor branches are given off to supply the segmental myotome.
Blocks of Nerves of the Trunk
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
The anterior ramus of the twelfth thoracic nerve passes below the last rib and thus is not classified as an intercostal nerve (it is usually termed the subcostal nerve). The anterior ramus of the first thoracic spinal nerve gives off (1) a large branch that reaches the neck and contributes fibers to the brachial plexus and (2) a small branch, which is the first intercostal nerve.
The Spleen(SP)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Subcostal nerve (T12): Supplies the skin in this region. The subcostal nerve communicates with the iliohypogastric, providing a nerve branch to the pyramidalis muscle and a lateral cutaneous branch that supplies sensation to the hip. The subcostal nerve, i.e., the anterior division of the 12th thoracic spinal nerve, is larger than the other intercostal nerves.
Corset trunkoplasty is able to preserve postoperative abdominal skin sensation in massive weight loss patients
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Kathrin Bachleitner, Maximilian Mahrhofer, Friedrich Knam, Thomas Schoeller, Laurenz Weitgasser
The loss of sensibility after a conventional abdominoplasty including undermining of the upper abdominal soft tissue flap can be explained by innervation and anatomy of the abdominal wall. The anterior branches of the 6th–12th intercostal nerves travel in a plane between the internal oblique and transverse abdominis muscles accompanied by artery and vein. These nerves penetrate the internal oblique fascia and separate into two individual branches, which enter the posterior sheath of the rectus abdominis muscle, resulting in segmental motor nerve supply. Sensitive innervation is supplied through separate perforating branches ultimately arborizing in the skin [19]. During conventional abdominoplasty skin flap elevation the anterior branches are inevitably severed, causing sensibility loss in the midline and lower abdominal region. The laterally extending suprapubic incision furthermore contributes to impairment of any additional sensory innervation from the branches of the iliohypogastric and ilioinguinal nerves and thus further decreases sensibility around the infraumbilical region. The preserved sensation in the upper abdomen can be explained by the lack of undermining in this area in conventional abdominoplasty techniques and sparing of the lateral cutaneous branches of the intercostal and subcostal nerves in this area. The extent of undermining of the abdominoplasty skin flaps represents the main determining factor of decrease in sensibility [19]. The lack of undermining of skin flaps in corset abdominoplasty techniques, therefore, contributes to maintenance of normal sensation of the abdominal skin in all areas.
Incisional lumbar hernia after the use of a lumbar artery perforator flap for breast reconstruction
Published in Acta Chirurgica Belgica, 2020
Stijn Van Cleven, Karel Claes, Aude Vanlander, Koenraad Van Landuyt, Frederik Berrevoet
Lumbar hernias are a protrusion of intra-abdominal content through a weakness or rupture in the posterior abdominal wall. Lumbar hernias are relatively rare defects. They are anatomically bound by the 12th rib superiorly, the iliac crest inferiorly, the erector spinae muscle medially, and the external oblique muscle laterally [5–7]. Lumbar hernias may be congenital (20%) or acquired (80%). Acquired hernias are primary (spontaneous) or secondary following surgery, trauma, or infection. The lumbar region contains 2 well-defined areas of weakness: the superior lumbar or Grynfeltt triangle and inferior lumbar or Petit triangle [5,7]. However, in large incisional defects a hernia can affect the entire lumbar region. Most postoperative incisional hernias occur after nephrectomy, adrenalectomy, aortic aneurysm surgery, resection of abdominal wall tumors, but have also been described following iliac bone graft harvest and latissimus dorsi myocutaneous flap [6,8–10]. The prevalence of lumbar hernia after lumbotomy is ∼20–30% [6]. Its pathogenic mechanism may be explained by dissection of the subcostal nerve, which involves muscular atrophy. Lumbar hernia after harvesting a lumbar artery perforator flap has not yet been described.
Occurrence of abdominal bulging and hernia after open partial nephrectomy: a retrospective cohort study
Published in Scandinavian Journal of Urology, 2018
Aapo Inkiläinen, Johan Styrke, Börje Ljungberg, Karin Strigård
The twelfth thoracic (subcostal) nerve runs inferior to the twelfth rib, and it, along with the eleventh intercostal nerve, provides the abdominal wall with motor and sensory innervation [11,12]. Damage to these nerves during surgery via a flank incision can be caused by division, retractor pressure, a suture or compression by fibrous tissue during the wound healing process. Nerve damage causes paraesthesia, pain and muscle denervation, the last of these leading to muscle atrophy and bulging of the abdominal wall. There is little in the literature regarding the rate of bulging after flank incision or the patient’s perception of deformity and symptoms, nor is there an accepted system for describing the degree of bulging. The rate of bulging has previously been reported to be 19–57% after both retroperitoneal aortic repair and OPN, both procedures using a flank incision in the eleventh intercostal space or below the twelfth rib [13–16]. Incisional hernia also occurs after flank incision, although little is known of its frequency.