3 8o 



APPLIED ANATOMY. 



between the transversalis fascia and the peritoneum. When it reaches the anterior 

 superior spine it passes between the transversalis and internal oblique muscles, and 

 just above the crest divides into an ascending branch which goes upward toward the 

 ribs and a posterior branch passing backward to anastomose with the iliolumbar. 

 The ascending branch is large and bleeds freely when cut. It is not infrequently 

 divided in operations for appendicitis in which the incision is carried far back. Its 

 depth from the surface, between the transversalis and internal oblique muscles, 

 should not be forgotten. 



Superficial Abdominal Veins. The upper part of the abdomen is drained 

 by small branches emptying into the superior epigastric, the intercostal, and laterally 

 into the axillary veins. Below, there are the superficial epigastric and superficial cir- 

 cumflex iliac veins. In cases of obstruction to the flow of blood in the large deep veins 



the superficial veins become visible; thus a 

 branch often becomes visible on the side run- 

 ning from the axillary vein to the superficial 

 epigastric or femoral vein, it is called by 

 Braune (" Das Venensystem des menschlicheii 

 Korpers," 1884, Joessel and Waldeyer, Topog. 

 chirurg. Anat., pp. 22, 147) the vena tho- 

 racica epigastrica longa tegumentosa (Fig. 

 392) . Other small veins around the umbilicus 

 become very much enlarged, and, branching 

 in various directions around the umbilicus, 

 have given rise to the term caput Medusa. 



Kelly ( M Operative Gynecology," p. 48) 

 describes two small veins running from the 

 symphysis up to the umbilicus in the subcu- 

 taneous tissue on each side of the linea alba, 

 and calls them ccliototny veins. 



Deep Veins of the Abdominal 

 W^alls. The superior epigastric, deep epi- 

 gastric, and circumflex iliac arteries are ac- 

 companied by veins. There is also a vein in 

 the round ligament of the liver emptying into 

 the portal vein, called by Schiff, and later by 1 

 Sappey, the vena par umbilicalis (Me'moires de 

 1'acad. de me"d. ", 1859). In some cases two 

 small veins can be seen on the interior of the 

 abdominal wall, running up to the umbilicus 

 from the symphysis on each side of the median 

 line, and two coming down to the umbilicus 

 on each side of the median line. 



Lymphatics. The superficial parts 

 above the umbilicus are drained by lymphatics 

 which empty into the axillary nodes; the ves- 

 sels below the umbilicus empty into the oblique 

 set of nodes in the groin. The lymphatics of the deep surface of the abdominal wall 

 above the umbilicus drain into the mediastinal nodes, while those below drain into 

 the pelvic lymphatics along the iliac arteries. 



Nerves. The front and sides of the abdomen are supplied by the anterior and 

 lateral cutaneous branches of the sixth, seventh, eighth, ninth, tenth, and eleventh inter- 

 costal nerves, the twelfth thoracic or subcostal, and the iliohypogastric and ilioingui- 

 nal branches of the first lumbar. The sides of the abdomen are supplied by the 

 lateral cutaneous branches which supply the skin as far forward as the rectus muscle. 

 The recti muscles and skin overlying them are supplied by the anterior brandies. 

 These pass forward between the internal oblique and transversalis muscles to enter 

 the sheath of the rectus, and. after supplying the muscle, pierce the anterior layer and 

 are distributed to the integument above. The sixth and seventh supply the infrasternal 

 region, the eighth about half way down to the umbilicus, the ninth just above the 



PIG. 392. Obstruction of the right iliac vein 

 from phlebitis. The vena thoracica epigastrica 

 longa is seen running from the groin up to the 

 axilla. 



