|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
| The rectus abdominis has a dual blood supply that branches freely in the central region of the muscle. The superior epigastric artery, a terminal branch of the internal mammary, enters at the junction of the xiphisternum and high diaphragmatic fiber insertion. The inferior epigastric artery arises from the external iliac artery below and behind the inguinal ligament to enter the posterior and lateral sheath at the level of the arcuate line. Each artery is accompanied by its venae comitantes, which drain into the internal mammary vein superiorly and the external iliac vein inferiorly. The inferior epigastric artery averages 2 to 4 mm and the superior 1 to 2 mm. Additionally, small segmental branches enter the sheath posteriorly and laterally from the lower six intercostal arteries. These vessels accompany the intercostal thoracic nerve between the transversalis and internal oblique muscles. There are also small connections with the ascending branch of the deep circumflex iliac vessels. The deep muscular system can support the skin overlying a large portion of the abdomen by several perforating vessels that communicate with the superficial vascular network. The most important of these perforators are located around the umbilicus.
The nerve supply, both sensory and motor, is segmental it nature, arising from T7 to T12.
Functionally, the rectus is a major anterior abdominal wall flexor.
A. In this preparation, a paramedian incision is made. The anterior rectus sheath is exposed and split in the middle. Muscle sheath attachments are divided to the medial and lateral borders of the muscle.
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