КЛИНИЧЕСКАЯ АНАТОМИЯ КРОВОСНАБЖЕНИЯ И ИННЕРВАЦИИ ПЕРЕДНЕБОКОВОЙ БРЮШНОЙ СТЕНКИ В ПРАКТИКЕ ХИРУРГА

Abstract

The arterial blood supply of the anterior abdominal wall comes from the superior, inferior, and superficial suprailiac arteries, the superficial and deep arteries enveloping the iliac crest, the external genital artery, the lumbar and intercostal arteries. The innervation of the anterior abdominal wall is carried out by the intercostal nerves, branches of the iliopsoas and iliac-subiliac nerves. All of these structures may have different topography in each particular patient. Most variations will not be pathologic, but they are worth keeping surgeons in mind when performing surgical interventions. For example, in severe sclerosis of the distal arteries or aorta, or in the case of aortic coarctation, there is significant vessel dilation to provide blood supply to the lower extremities. Transection of the epigastric arteries in such cases can lead to more severe bleeding and ischemia of the lower extremities. Variation in the location of the branch of the deep inferior epigastric artery, the crown of death, occurs in 77% of patients and can cause life-threatening hemorrhagic shock. Also of clinical importance is the replacement of the areas of sensitive innervation of the iliopsoas and iliac-subiliac nerves during operations on inguinal hernia and during blockade anesthesia. Thus, surgeons need to be aware of variations in the blood supply and innervation of the anterolateral abdominal wall during surgical interventions, particularly during trocar insertion and other surgical manipulations. In order to improve surgical technique, it is suggested to introduce convenient and relatively inexpensive neuroimaging or neuromapping methods into routine practice.