Incision and closure of the abdominal wall are among the most frequently performed surgical procedures. The abdominal wall is defined cranially by the xiphoid process of the sternum and the costal margins, and caudally by the iliac and pubic bones of the pelvis. It extends to the lumbar spine, which joins the thorax and pelvis and is a point of attachment for some abdominal wall structures .
Integrity of the anterior abdominal wall is primarily dependent upon the abdominal muscles and their conjoined tendons. These muscles assist with respiration and control the expulsive efforts of urination, defecation, coughing, and parturition. They also work with the back muscles to flex and extend the trunk at the hips, rotate the trunk at the waist, and protect viscera by becoming rigid.
The contour of the abdomen is dependent upon age, muscle mass, muscle tone, obesity, intraabdominal pathology, parity, and posture. These factors may significantly alter topography, and become a major obstacle to proper incision selection and placement .
Knowledge of the layered structure of the abdominal wall permits efficient and safe entry into the peritoneal cavity. The principal structures from exterior to interior are: skin, subcutaneous tissue, muscles with an aponeurosis, transversalis fascia, preperitoneal fat, and peritoneum. Nerves, blood vessels, and lymphatics are present throughout.
Abdominal wall anatomy that is clinically pertinent to the surgeon, focusing primarily on the structures of the anterior abdominal wall will be reviewed. Common incisions and closure techniques, and prevention and management of wound complications are discussed elsewhere. (See "Incisions for open abdominal surgery" and "Principles of abdominal wall closure" and "Complications of abdominal surgical incisions".)