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The body wall

image of The body wall
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Abstract

The body wall consists of sheets of muscle that maintain abdominal integrity, provide support and strength for movements such as jumping and twisting and, when tense, are rigid enough to protect the abdominal contents. Open surgery on intra-abdominal structures involves breaching this well designed system, and it is important to ensure a robust and long-lasting repair of any approach to the abdominal cavity. This chapter covers the body wall anatomy, surgical approaches, closure, and complications. Practical tips are highlighted throughout. Midline laparotomy (coeliotomy); Flank laparotomy; Inguinal hernia repair; Prepubic tendon rupture repair.

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Figures

Image of 4.3
4.3 (a) Cross-section of the abdominal wall muscles, showing aponeuroses inserting on the linea alba. (b) External view of the ventral surface of the abdomen and abdominal wall openings. EAO = external abdominal oblique; IAO = internal abdominal oblique; RA = rectus abdominis; TA = transversus abdominis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 4.4
4.4 Anatomy of the inguinal ring in the dog. (a) Internal inguinal ring. (b) External inguinal ring. EAO = external abdominal oblique; IAO = internal abdominal oblique; RA = rectus abdominis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 4.5
4.5 Lateral view of inguinal area in the dog. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 4.6
4.6 Surgical approaches to the abdomen. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.8 Midline incisional hernia with herniated abdominal contents (evisceration).
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4.10 An example of postoperative discharge instructions.
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4.11 Abdominal wall (paracostal) hernia in a cat.
Image of 4.13
4.13 Inguinal hernia in a 5-year-old male hound. Note the dramatic scrotal swelling. (Courtesy of J Niles)
Image of 4.14
4.14 Inguinal hernia. (a) Indirect herniation and (b) direct herniation in the male dog. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 4.15
4.15 Necrotic jejunum that had become incarcerated in the inguinal canal of the dog in Figure 4.13 . Note: a scrotal ablation and abdominal exploratory were performed in this dog. (Courtesy of J Niles)
Image of 4.16
4.16 A sheet of porcine SIS being used to repair a chronic abdominal wall hernia. Note how the polypropylene mattress sutures have been pre-placed. (Courtesy of J Niles)
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4.18 Prepubic tendon rupture in a Domestic Shorthaired cat following a road traffic accident. The cat’s head is to the right of the photograph. The abdominal wall (black arrows) has been avulsed from the pubis (white arrow). The bladder can be seen in the centre of the picture. (Courtesy of J Niles)
Image of 4.19
4.19 Devitalized area of jejunum found on abdominal exploration prior to repair of the prepubic tendon in the cat in Figure 4.18 . An intestinal resection and anastomosis were performed. (Courtesy of J Niles)
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4.20 Cat with prepubic tendon rupture clipped for surgery (note extensive bruising).
Image of 4.21
4.21 Paracostal hernia repair. Muscle layers are attached to the costal arch sequentially, using mattress sutures anchored to the ribs. EAO = external abdominal oblique muscle; IAO = internal abdominal oblique muscle; IC = intercostalis muscles; RA = rectus abdominis; TA = transversus abdominis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 4.22
4.22 (a) Inguinal seromas usually present with a non-painful soft fluctuant swelling in the inguinal area. This cat has a bilateral swelling that is predominantly situated in the inguinal area, even when the forelimbs are elevated. (b) In dorsal recumbency, during preparation for surgery, palpation of the caudal abdominal wall is unremarkable and the seroma spreads bilaterally over the inguinal area. (a, Reproduced from with permission from the ; b, © Tim Charlesworth)
Image of Midline laparotomy with incision deviating laterally around the prepuce (the forceps are grasping the severed preputial muscle).
Midline laparotomy with incision deviating laterally around the prepuce (the forceps are grasping the severed preputial muscle). Midline laparotomy with incision deviating laterally around the prepuce (the forceps are grasping the severed preputial muscle).
Image of Mayo scissors being used to enlarge incision in linea alba.
Mayo scissors being used to enlarge incision in linea alba. Mayo scissors being used to enlarge incision in linea alba.
Image of Scalpel being used to extend linea alba incision. Underlying organs are protected by elevating the linea alba prior to incision.
Scalpel being used to extend linea alba incision. Underlying organs are protected by elevating the linea alba prior to incision. Scalpel being used to extend linea alba incision. Underlying organs are protected by elevating the linea alba prior to incision.
Image of Sutures are pre-placed using PTFE pledgets to reduce the risk of them tearing through when tightened. (© J Williams)
Sutures are pre-placed using PTFE pledgets to reduce the risk of them tearing through when tightened. (© J Williams) Sutures are pre-placed using PTFE pledgets to reduce the risk of them tearing through when tightened. (© J Williams)
Image of (© J Williams)
(© J Williams) (© J Williams)

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