Fasciae and ligaments
- Superficial fascia: Its fatty and membranous layers cover the abdominal wall. The membranous layer continues into the perineum as Scarpa fascia and attaches to fascia lata below the inguinal ligament.
- The fatty layer contains more fat, the membranous layer is tougher and sheet-like, Scarpa fascia is the named membranous layer of the lower anterior abdominal wall, and fascia lata is deep fascia of the thigh.
- Deep abdominal fascia: This fascia invests the abdominal muscles and provides planes for vessels, nerves, and surgical dissection.
- Linea alba: Interlacing aponeuroses create this midline fibrous raphe. It is relatively avascular and is commonly used for midline surgical access.
- An aponeurosis is a flat tendon sheet, and a raphe is a seam where tissues from opposite sides join.
- Linea semilunaris: This curved line marks the lateral border of rectus abdominis. It represents the transition from rectus sheath to the aponeurotic abdominal wall.
- Arcuate line: It marks the inferior limit of the posterior rectus sheath. Below it, all three flat-muscle aponeuroses pass anterior to rectus abdominis.
- The linea semilunaris marks the lateral edge of the rectus sheath, while the arcuate line marks where the posterior rectus sheath ends inferiorly.
- Inguinal ligament: The rolled inferior border of the external oblique aponeurosis extends from the anterior superior iliac spine to the pubic tubercle. It forms the floor of the inguinal canal.
- Lacunar and pectineal ligaments: The lacunar ligament is a medial expansion of the inguinal ligament, while the pectineal ligament continues along the pectineal line. Both reinforce the medial groin.
- The inguinal ligament is the rolled lower edge of external oblique, the lacunar ligament fans medially from it, and the pectineal ligament continues along the pubic bone's pectineal line.
- Iliopectineal arch: This fascial thickening separates the muscular and vascular lacunae beneath the inguinal ligament. It helps organize passage of the femoral nerve, iliopsoas, and femoral vessels.
- A lacuna is a compartment or space; the muscular lacuna carries iliopsoas and femoral nerve, while the vascular lacuna carries major femoral vessels beneath the inguinal ligament.
- Conjoint tendon: Fused aponeuroses of internal oblique and transversus abdominis attach near the pubis as the conjoint tendon. Its medial position reinforces a potential weak region.
- The conjoint tendon helps strengthen the medial posterior wall of the inguinal canal, a region near where direct inguinal hernias can occur.
- Rectus sheath: It encloses rectus abdominis and contains epigastric vessels. Above the arcuate line, internal oblique splits around rectus; below it, all three flat-muscle aponeuroses lie anterior to rectus.
- Below the arcuate line, rectus abdominis has less posterior aponeurotic covering, so only transversalis fascia and peritoneal layers separate it from deeper abdominal contents.
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