The anatomic study of the female reproductive tract and related anatomy is a necessary adjunct to proper diagnosis and treatment of gynecologic disease. Such knowledge is a prerequisite of advanced surgical technique. This text presents this information from both a surgical and an anatomic perspective.
Anterior Lateral Abdominal Wall
Anatomic study of the abdomen includes the abdomen proper and the pelvis. The perineum is continuous with the anterior abdominal wall and is located at the outlet of the pelvis, For descriptive purposes, the abdomen can be divided into nine regions by three horizontal and two vertical planes.
The superficial fascia of the anterior abdominal wall is composed of Camper’s fascia, which is the superficial fatty layer . It is continuous over the inguinal ligament with the similar corresponding layer of the thigh and medially continues into the labia majora.
The deep layer of the membranous subcutaneous fascia is identified as Scarpa’s fascia and is a membranous sheath containing little or no adipose tissue , It forms a continuous sheath across the midline, where it attaches to the linea alba. Inferiorly it passes over the inguinal ligament and is securely attached to either the ligament itself or to the fascia lata just beyond it. Inferior to the ligament, the corresponding layer is called the fascia cribrosa as it covers and fills the fossa ovalis. At the medial end of the inguinal ligament, it passes over the external inguinal ring without attachment and continues along the groove between the labia majora and thigh into the perineum, where it is called the fascia of Colles. These attachments of Scarpa’s fascia form a gutter that empties into the superficial perineal pouch. The abdomen and perineum communicate through the abdominal labial opening posterior to the fascia of Scarpa and Colles. Hemorrhage of the anterior abdominal wall may be associated with extravasation into the perineum.
Anatomical subdivisions of the anterior abdominal wall.
The deep fascia (Gallaudet’s fascia) is identified easily in the lateral portion of the anterior abdominal wall, where it covers the fleshy fibers of the external oblique muscle. It is continuous with the fascia of the latissimus dorsi and the pectoralis major. More medially, it is indistinguishable from the muscular fascia of the external abdominal oblique muscle, and it is thickened in the midline to form the suspensory ligament of the clitoris.
In the superficial fascia of Camper, the superficial circumflex iliac artery, the superficial epigastric artery, and the superficial external pudendal artery are seen as inguinal branches of the femoral artery, whereas the corresponding venous tributaries drain into the great saphenous vein.