linea alba. The actual defect occurs at the intersection of the linea semicircularis, linea semilunaris, and the lateral border of the rectus abdominis muscle. Spigelian hernias occur through a weakness of the lateral rectus abdominis sheath at its margin with the oblique muscles (linea semilunaris), particularly at the point where the inferior epigastric vessels penetrate the rectus sheath (Fig. The typical component separation release separates the external oblique muscle and aponeurosis from its connection to the anterior rectus fascia from the costal margin to the iliac crest at a level just lateral to the linea semilunaris. It is the site of a Spigelian hernia. ... it extends from the pubic tubercle towards the linea alba. Walter PegoliJr. Proboscoid hernias may be referred for surgical repair early for social, cosmetic, or skin integrity concerns. - nerves of lumbar plexus - psoas major M. Umbilical hernia—type of abdominal hernia in which part of the intestine protrudes at the umbilicus and is covered by skin and subcutaneous tissue, Epigastric hernia—an abdominal hernia through the linea alba above the level of the umbilicus, Spigelian hernia—an abdominal hernia through the linea semilunaris, Lumbar hernia—herniation of omentum or intestine in the lumbar region of the back, Parastomal hernia—herniation of omentum or intestine adjacent to the fascial exit of an enterostomy, Incisional hernia—an abdominal hernia at the site of a previously made incision. The linea semilunaris (also semilunar line or Spigelian line) is a curved tendinous intersection found on either side of the rectus abdominis muscle. Umbilical hernias are seen in 1 of every 6 children. Symptomatic hernias require repair. An elliptical incision is drawn on the lower abdomen preoperatively while the patient is in the upright position. The lateral border of the rectus abdominis muscle usually can be seen on the surface of the anterior abdominal wall and is termed the, Pediatric Clinical Advisor (Second Edition). The rectus abdominis muscle is supplied by the anterior primary divisions of the lower six or seven thoracic spinal nerves. Between the linea semilunaris and the linea alba, the aponeurosis helps to form the rectus sheath. Incisional hernias are caused by wound infection, obesity, or errors in surgical technique. The lateral border of the rectus abdominis muscle usually can be seen on the surface of the anterior abdominal wall and is termed the linea semilunaris. The linea alba separates the right and left rectus abdominis muscles. By continuing you agree to the use of cookies. along the linea alba. Synonym (s): semilunar line, Spigelius line. When the thorax and pelvis are fixed, these muscles, especially the obliques, increase the intraabdominal pressure. It has already been noted that the rectus abdominis muscle can be raised with a motor supply from one or more of the thoracic nerves (T7 to T12). Epigastric hernias are differentiated from diastasis recti, which is an attenuation, but not a defect, in the linea alba. A tension-free closure is important to prevent recurrence in this area that has a high level of muscle tension. Beginning with the use of smaller, less aggressive cannulas and modified abdominal etching (etching linea alba and linea semilunaris only) is a safe approach for the surgeon starting to use this technique. Medical Dictionary for the Health Professions and Nursing © Farlex 2012. The inferior skin incision is then completed as described for the superior incision. This is reinforced anteriorly by the external oblique, and posteriorly by the transversus abdominis above the arcuate line. The flap is elevated in a lateral to medial fashion until the medial edge (i.e., linea alba) and the lateral edge (i.e., linea semilunaris) of the rectus sheath are exposed. • Anatomy photo:35:06-0102 at the SUNY Downstate Medical Center - "The Linea Alba and Linea Semilunaris" Epigastric hernias, which are located between the xiphoid process and the umbilicus, result from fascial defects arising at the site of penetration of the fascia by blood vessels or from tears in the linea alba induced by coughing, straining, or abdominal distension. The umbilicus is usually between the L3 and L5 vertebral level, but its position is highly variable. The hernia is usually composed of bowel and results in ischemia or obstruction. Umbilical hernias result from a failure of obliteration of the site in the abdominal wall through which the umbilical vessels exited the fetus to join the placenta. Most often, the rectus muscle contralateral to the mastectomy site is used for reconstruction. What is the linea semilunaris? - linea alba - the Mesentery - rectus abdominis M. - linea semilunaris - ascending colon - transversus abdominis M. - internal abdominal oblique M. - external abdominal oblique M. - ilium - descending colon - iliacus M. - genitofemoral N. - sacrum - abdominal aorta & inferior vena cava - erector spinae mm. The external oblique can then be separated off the internal oblique with blunt dissection, avoiding injury to the internal oblique fascia and allowing the muscles to slide relative to one other (Fig. lines going down the middle. Bupivacaine has been the most commonly used local anesthetic. Sophoclis Alexopoulos MD, FACS, ... Seth J. Karp MD, in Chronic Kidney Disease, Dialysis, and Transplantation (Fourth Edition), 2019. Lumbar hernias are among the rarest of abdominal wall hernias and may be congenital, posttraumatic, or postoperative. They are more common with trisomy 13, 18, and 21. Both anastomoses are done in an end-to-side fashion. For deceased donors, the donor artery uses a Carrel patch of aorta to minimize the risk for stenosis, and for live donors, an arterial punch may be used to increase the diameter of the arteriotomy in the recipient for the same reason. 22-2). This arrangement changes about halfway between the umbilicus and pubic symphysis, forming a curved line known as the arcuate line. Spigelian hernias are quite rare in children and can be difficult to detect and diagnose. 22-3). The needle is inserted 0.5 cm medial to the, Musculoskeletal ultrasound of the adult hip and groin, Spigelian hernias occur through a weakness of the lateral rectus abdominis sheath at its margin with the oblique muscles (, Surgical Management of the Renal Transplant Recipient, Chronic Kidney Disease, Dialysis, and Transplantation (Fourth Edition), Laterality does not significantly affect the approach. Sometimes this aponeurosis is called the rectus sheath. Ultrasonography may aid in the diagnosis. The needle is inserted 0.5 cm medial to the linea semilunaris in a perpendicular plane, just above or below the umbilicus (Fig. Sometimes the most lateral fibers may reach the fourth or even third costal cartilages. 1.6 Musculofascial system of the abdomen. external obliques comes up to the ..... and goes anterior to the ..... linea semilunaris rectus abdominis. The semilunar line, linea semilunaris or Spigelian line is a bilateral vertical curved line in the anterior abdominal wall where the layers of the rectus sheath fuse lateral to the rectus abdominis muscle and medial to the oblique muscles. However, the mobility of the innervated rectus abdominis–internal oblique–transversus abdominis muscle complex should routinely be evaluated to prevent excessive dissection laterally, therefore decreasing the chances for an accidental deep fascial injury. Barclay W. Bakkum, Gregory D. Cramer, in Clinical Anatomy of the Spine, Spinal Cord, and Ans (Third Edition), 2014. A retrospective review was performed of patients presenting with abdominal wall pain at the linea semilunaris … The linea semilunaris (also semilunar line or Spigelian line) is a curved tendinous intersection found on either side of the rectus abdominis muscle. The technical aspects of kidney transplantation are well described and have not significantly changed in the past several decades.27,28 Laterality does not significantly affect the approach. They can be classified as Spigelian, incisional and umbilical.6,28. 1.6). A curvilinear incision (hockey stick) is typically made from the level of the anterior superior iliac spine to immediately cephalad to the lateral aspect of the pubic tubercle, while staying lateral to the rectus abdominis and, Gowned and Gloved Surgery: Introduction to Common Procedures, Clinical Anatomy of the Spine, Spinal Cord, and Ans (Third Edition), ) is a long, straplike muscle extending the entire length of the anterior abdominal wall. They are more common with hypothyroidism, mucopolysaccharidoses, and Beckwith‐Wiedemann syndrome. 55-9). Umbilical hernias protrude when the child strains or cries and spontaneously reduce when the child is supine and at rest. The contralateral linea alba is also identified and marked. It is also the basis of the Valsalva maneuver (i.e., increasing abdominal pressure for diagnostic purposes). This muscle attaches inferiorly to the pubic crest (sometimes as far laterally as the pecten pubis) and also to ligamentous fibers anterior to the symphysis pubis. Incisional hernias arise from muscular weakness and fascial defects due to previous surgery and scar tissue. 1 Definition. Urken and colleagues describe a case of radical parotidectomy in which good voluntary and involuntary dynamic activity was obtained 9 months following reconstruction of a patient in whom two segmental nerves were anastomosed to the main divisions of the ipsilateral facial nerve trunk.17. For all these conditions the area to be evaluated can be confirmed on taking a history. Furosemide and mannitol may be administered at this time per surgeon preference. The flap, consisting of muscle and anterior sheath, is then transected inferiorly. The linea alba runs down the middle of the muscle, dividing it into two longitudinal sections. In addition, the external abdominal oblique muscle can help produce rotation of the trunk away from the side of contraction, whereas the internal oblique muscle turns it to the same side. If the thorax is fixed, the lumbar spine still flexes, but the pelvis is moved upward. A well-perfused kidney should immediately become pink with a palpable arterial pulsation and thrill (Fig. The external abdominal oblique muscle can further aid expiration by depressing the lower ribs. In addition, the technical tools required to attain the anatomical details present on the ideal aesthetic abdomen were limited prior to the publica… Anterior wall: Paired rectus muscles enclosed by rectus sheath (aponeurosis of internal oblique, external oblique, and transversus abdominis muscles), which laterally forms linea semilunaris and centrally fuses to form linea alba Anterolateral-lateral wall: External oblique, internal oblique, and transversus abdominis In the upper portion of the anterior abdominal wall, the external oblique and anterior lamina of the internal oblique aponeuroses pass anteriorly to the rectus abdominis muscle, whereas the posterior lamina of the internal oblique and transverse aponeuroses lie posterior to the rectus abdominis muscle. Often, there is a palpable defect in the fascia. ris. It usually involves absence or attenuation of the transversus abdominis and internal oblique muscles. The rectus abdominis muscle gives rise to abdominal markings. Patrick Narchi, ... Xavier Paqueron, in Raj's Practical Management of Pain (Fourth Edition), 2008. With unilateral contraction the trunk is laterally flexed to that side. The needle is then further advanced until the posterior aspect of the rectus sheath is appreciated with a scratching sensation as the needle is moved, again with a back and forth motion. Lumbar hernias present as flank swellings that protrude with crying. The abdominal fascia is repaired with prosthetic mesh. Linea semilunares are at lateral borders of rectus abdominis. They may appear as intermittent masses in the lower abdomen, lateral to the edge of the rectus abdominus muscle. In most cases, the reconstruction procedure begins simultaneously with the mastectomy and is carried out by a separate surgical team. The actual defect occurs at the intersection of the linea semicircularis, Raj's Practical Management of Pain (Fourth Edition), The aim of the block is to inject the local anesthetic solution between the muscle and posterior aspect of the rectus sheath. A subcutaneous tunnel is developed at the inframammary crease to allow passage of the flap from the abdomen to the breast. They are readily apparent when the child holds his or her arms above the head and performs a Valsalva maneuver. The linea alba is the vertical line that divides the rectus abdominis or “six-pack” muscle into left and right halves. Repair consists of a transverse incision over the defect with excision of the sac and closure of the defect. It courses between the rectus abdominis muscle from the xiphoid process of the sternum to the symphysis pubis. The linea alba forms the medial border of this muscle and separates the two (right and left). Primary repair should be performed with nonabsorbable suture material. The rectus muscle is elevated off of the posterior rectus sheath. Typical anastomotic technique is the Lich-Greigor, which is a mucosal-to-mucosal anastomosis. The vascular anastomoses are completed before connecting fascicles of the sural nerve to the thoracic nerves. MD, George T. Drugas MD, in Pediatric Clinical Advisor (Second Edition), 2007. The rectus abdominis is identified after incising the entire rectus sheath from the linea alba to the linea semilunaris. The linea alba forms the medial border of this muscle and separates the two (right and left). Typically they are found at the level of the umbilicus, the inferior tip of the xiphoid process, and halfway between these two points. The aim of the block is to inject the local anesthetic solution between the muscle and posterior aspect of the rectus sheath. A curvilinear incision (hockey stick) is typically made from the level of the anterior superior iliac spine to immediately cephalad to the lateral aspect of the pubic tubercle, while staying lateral to the rectus abdominis and linea semilunaris muscles. The rectus sheath is then incised medially and laterally up to the costal margin. (Linea semilunaris labeled vertically at center, at border between brown and gray.). [3], The Obliquus externus abdominis. These hernias are often associated with low birth weight and occur with higher incidence among premature infants. Medical Dictionary for the Health Professions and Nursing © Farlex 2012. Umbilical or paraumbilical hernias present in the midline and can be congenital, postpartum or in patients with abdominal distension (obesity or ascites). Thomas R. Weber MD, in Ashcraft's Pediatric Surgery (Fifth Edition), 2010. A midline transverse section US view of the linea alba (arrow) and the rectus abdominis muscles on either side (RA), the anterior (black arrowhead) and posterior (white arrowhead) components of the rectus sheath are shown The initial longitudinal incision should be placed 1 cm lateral to the linea semilunaris. Spegelian hernias occur below the arcuate line where the inferior epigas-tric vessels traverse the fascia. ( lin'ē-ă al'bă) [TA] A fibrous band running vertically the entire length of the center of the anterior abdominal wall, receiving the attachments of the oblique and transverse abdominal muscles. Often, prosthetic material is needed to help close the defect without tension. Hernia is a protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. ... linea semilunaris rectus abdominis linea alba rectus abdominis muscles. Linea semilunaris : a curved vertical line on the anterior abdominal wall at the lateral edge of each rectus abdominis muscle Herniation of intra-abdominal contents through the linea semilunaris is known as a Spigelian hernia . The lower abdominal tissue can also be transferred without preserving the superior epigastric vessels. 4-8, A) is a long, straplike muscle extending the entire length of the anterior abdominal wall. Parastomal hernias occur adjacent to a stoma. Patrick Narchi, ... Barry Nicholls, in Practical Management of Pain (Fifth Edition), 2014. Once the linea semilunaris is identified by ultrasound, a line is drawn with the skin marker to mark this landmark externally for later identification during optical entry. The transversus abdominis muscle probably has an effect only on the abdominal viscera and does not produce any appreciable movement of the vertebral column, although rotational movements are a distinct possibility (Standring et al., 2008). Spigelian hernias are quite rare in children and can be difficult to detect and diagnose. A section of the rectus muscle containing the deep inferior epigastric vessels, as well as any perforators to the overlying fat and skin, is excised. These can be identified by careful dissection at the lateral aspect of the muscle (linea semilunaris) where they run between the internal oblique and transversus abdominis muscle layers. The free TRAM flap is detached from the body, and the deep inferior epigastric vessels are then re-anastomosed to either the internal mammary or the thoracodorsal vessels using microsurgical techniques (Fig. The lateral border of the rectus abdominis muscle usually can be seen on the surface of the anterior abdominal wall and is termed the linea semilunaris. Previous methods have not consistently placed a primary emphasis on recreating specific anatomical features of the native abdomen. Immunosuppression is typically administered before reperfusion. This is important for childbirth, forced expiration, emptying the bladder and rectum, and vomiting. it interlocks with the reflected ligament from the other side of the body. Just above the public crest the aponeurosis of the external oblique muscle presents a triangular aperture called the superficial inguinal ring. If the pelvis is fixed, these muscles, primarily the recti, bend the trunk forward and flex the lumbar spine (Brown et al., 2011). [citation needed] It is formed by the aponeurosis of the internal oblique at its line of division to enclose the rectus. Description. Less cardiotoxic drugs such as 0.5% ropivacaine or levobupivacaine are effective alternatives, particularly when high doses are used. The flap is then tunneled up to the breast and sutured to the chest wall. Because of its indirect attachment to the lumbar transverse processes via the thoracolumbar fascia, it is possible that this muscle also plays a role in lumbar segmental control (Barker et al., 2007). The upper abdominal flap is developed up to the costal margin in the plane immediately superficial to the abdominal wall fascia. Die überwiegend horizontal verlaufenden Fasern des Musculus transversus abdominis gehen weit lateral vom Musculus rectus abdominis in der Linea semilunaris in ihre Aponeurose über. Synonym (s): white line (1) . In teens and adults, obesity, multiple pregnancies, and ascites may be precursors. Fascial rings smaller than 1 cm in toddlers usually close spontaneously. The picture shows the ventral view on the abdominal muscles: 1 = Linea semilunaris 2 = aponeurosis of the transversal abdominal muscle 3 = external oblique abdominal muscle 4 = rectus muscle 5 = Linea alba 6 = internal oblique abdominal muscle Generally, the fascial planes are quite distinct and allow for easy dissection. The inferior epigastric artery and vein are typically encountered caudally and divided to allow better exposure to the bladder. Actually composed of eight sections of muscle that are delineated by several lines of connective tissue — three horizontal lines and the linea alba — the rectus abdominis extends from the sternum to the pelvis . Superiorly this muscle attaches to the fifth through seventh costal cartilages and the xiphoid process. Spigelian hernias are rarely seen in childhood. More recently, it has been used for midline incisions above and below the umbilicus and for postoperative analgesia as part of an enhanced postoperative recovery technique consisting of the use of indwelling local anaesthetic catheters.65 Because of crossover innervation, bilateral blocks need to be performed in all patients.
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