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The pelvic bones are
-the sacrum (the termination of the axial skeleton)
-and the two innominate bones
Innominate bones are formed by
-fusion of
-the iliac
-the ischial
-and pubic  ossifications
-centers at the acetabulum
The ischium and pubis
-meet below
-in the center of inferior ramus
-to form the obturator foramen
Pelvis is divided into
-bowl-shaped false pelvis
-circular true pelvis
Bowl-shaped false pelvis formed by
-iliac fossae
-and largely in contact with intraperitoneal organs
Circular true pelvis in contact with
-urogenital organs
True and false pelves are separated by
- the arcuate line
Arcuate line extends from
-the sacral promontory
-to the pectineal line of the pubis
The palpable landnarks of the pelvis
-anterior and posterior iliac spines
-the iliac crests
-the pubic tubercles
-ischial tuberosities
Cooper (pectineal ligament)
-overlies pectineal line
-offers a sure hold for sutures in hernia repairs and urethral suspension procedures
The sacrospinatus ligament separates
-the greater and lesser sciatic foramina
Langer lines of cleavage
-parallel dermal collagen fibers
-oriented along lines of stress
-correspond to the segmental thoracic and lumbar nerves
Camper facia
-backes the skin
-a loose layer of fatty tissue
-varies in thickness with the nutritional status
Vessels that run in layer of Camper fascia
-superficial circumflex iliac
-external pudendal
-superficial inferior epigastric vessels
Superficial inferior epigastric vessels
-are encountered during inguinal incisions
-can cause troublesome bleeding during placement of pelvic laparoscopic ports
Scarpa fascia
- a distinct layer deep to Camper fascia
-superiorly and laterally blends with Camper fascia
-medially it is continuous with Colles fascia of the perineum
Colles fascia attaches
-to the posterior edge of the urogenital diaphragm and the inferior ischiopubic rami
-and is continuous with the dartos fascia of penis and scrotum
Colles fascia can limit
-spread of infection (Fournier gangrene)
-extent of urinary extravasation (anterior urethral injury)
Blood and urine after anterior urethral injury can accumulate
-in the scrotum and penis
-deep to the dartos fascia
Spread of blood and urine after injury of anterior urethra is limited  by
-fusions of Colles fascia
-to the ischiopubic rami laterally and
-to the posterior edge of the perineal membrane
-batterfly shaped hematoma
Colles fascia gives to blood and urine extend
-to the clavicles and around the flanks to the back
-but down the leg or into the buttock
Arcuate line
-2/3 of the distance from the pubis to the umbilicus
Anterior rectus sheath above arcuate line
-aponeurosis of external oblique muscle
-portion of the aponeurosis of the internal oblique mucle
Posterior rectus sheath above arcuate line
-portion of the aponeurosis of the internal oblique muscle
-and the transversus abdominis aponeurosis
Anterior rectus sheath below arcuate line
-external and internal abdominis aponeurosis
Posterior rectus sheath below arcuate line
-only the transversus abdominis aponeurosis and peritoneum
The rectus abdominis muscle arises
-from the pubis
-inserts on the xyphoid process and adjacent costal cartilages
The rectus abdominis muscle supplied by
-the last six thoracic segmental nerves
-that enter it laterally
Paramedian incisions lateral to the rectus divide nerves supplying the rectus abdominis
-atrophy of the rectus and predispose to ventral herina
Pyramidalis muscle
-anterior to the rectus and within its sheath
-the triangle shaped
-arises from pubic crest and iserts into the linea alba
Nerve supplying of the pyramidalis muscle
-subcostal nerve T12
Inguinal canal transmits
-the spermatic cord in the males
-the round ligament in the female
-the ilioinguinal nerve in both sexes
The anterior wall of the inguinal canal
-external oblique muscle
The posterior wall of inguinal canal
-transversalis fascia
The cord structures pierce the transversalis fascia
-lateral to the inferior epigastric vessels
-at the internal inguinal ring
Conjoint tendon
-fibers from internal oblique and transversus abdominis muscle
-lateral to the internal iliac ring
-arch over the canal to form its roof
Hernias medial to the inferior epigastric vessels
-direct
Hernias lateral to the inferior epigastric vessels
-indirect
Visible elements of abdominal wall below the umbilicus
-median
-medial
-lateral umbilical folds
The median fold
-overlies the median umbilical ligament (urachus)
-a fibrous remnant of the cloaca
-that attaches to the bladder to the anterior abdominal wall
Medial umbilical fold
-contains oblitareted umbilical artery
Oblitareted umblilical artery
-may be traced to its origin the internal iliac artery
Ureter
-lies on medial side of internal iliac artery
The obturator packet during lap.l/n dissection
-is accessed by incising the peritoneum lateral to oblitareted umbilical artery
The medial umbilical arteries
-are landmarks to guide the dissection of the bladder
-to expose the spase of Retzius
Lateral umbilical folds
-contains the inferior epigastric vessels
-as they ascend to supply the rectus abdominis
The obturator internus muscle
-arises from the inner surface of the obturator foramen and the obturator mebrane
-passes through the lesser sciatic foramen to insert on the femur
Levator ani muscle includes
-puborectalis muscle
-pubococcygeus muscle
-iliococcygeus muscle
The muscles bordering U-shaped hiatus
-pubovisceral muscles
-provide sling for (pubourethralis and puborectalis muscles)
Pubovisceral groups of muscles provides
-strong fixation and support for pelvic viscera
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