Figure 18 - This photograph shows the repair of the rectus sheath.

The posterior rectus sheath finishes 2-3cm below the umbilicus with a semilunar line.

Complete the opening of the peritoneum and posterior rectus sheath using dissecting scissors.

Spontaneous rectus sheath hematoma arises from rupture of the epigastric vessels.

It usually involves the insertion of mesh to the rectus sheath or abdominal wall but can be used to support deeper tissue structures.

The muscles are innervated by thoracoabdominal nerves, which pierce the anterior layer of the rectus sheath.

The rectus sheath is formed by the aponeuroses of the transversus abdominis and the external and internal oblique muscles.

Have your assistant hold the edge of freed peritoneum and posterior rectus sheath with artery forceps to put delicate countertraction on the adhesions.

The pyramidalis is a small and triangular muscle, anterior to the rectus abdominis, and contained in the rectus sheath.

A rectus sheath hematoma is an accumulation of blood in the sheath of the rectus abdominis muscle.

Above the arcuate line, the rectus abdominis is surrounded by an anterior layer of the rectus sheath and a posterior layer.

The rectus abdominis muscle is contained in the rectus sheath, which consists of the aponeuroses of the lateral abdominal muscles.

In rectus sheath haematoma, the haematoma produces a mass that does not cross the midline and remains palpable when the rectus muscle is tense.

The operation involves a lateral cut in the rectus sheath, overlapping the upper and lower edges of the aponeurotic segments, and closing with a series of mattress stitches.

It is advisable not to separate the rectus muscles from the anterior rectus sheath to prevent their retraction, which in turn facilitates closure at the end of the procedure.

Therefore, the flap can be raised without incising the anterior rectus sheath and dissecting within the rectus muscles and thus further reducing the chance of donor site morbidity.

Adults: new-onset Crohn's disease, ulcerative colitis, regional enteritis, renal colic, perforated peptic ulcer, pancreatitis, rectus sheath hematoma and epipliocitis.

Inferior to the arcuate line, all three muscle aponeuroses make up the rectus sheath, that is now only anterior to the rectus abdominis and not posterior to it at all.

A positive test increases the likelihood that the abdominal wall and not the abdominal cavity is the source of the pain (for example, due to rectus sheath hematoma instead of appendicitis).

If a mass in the abdominal wall does not cross midline and does not change with flexion of the rectus muscles, this is a positive sign for a rectus sheath hematoma.

A modification was introduced by Nyhus which used a transverse (oblique) skin incision 3 cm above the inguinal ligament and a transverse incision (oblique) to divide the anterior rectus sheath.

There is a common misconception that they protrude below the arcuate line owing to deficiency of the posterior rectus sheath at that level, but in fact the defect is almost always above the arcuate line.

McEvedy's incision - McEvedy's original incision was a lateral paramedian incision which used to incise the rectus sheath along its lateral margin and gain access by pulling the rectus medially.

The sternalis muscle often originates from the upper part of the sternum and can display varying insertions such as the pectoral fascia, lower ribs, costal cartilages, rectus sheath, aponeurosis of the abdominal external oblique muscle.

The differential diagnosis of a positive Carnett's test includes hernias, nerve entrapment syndrome, irritation of intercostal nerve roots, anterior cutaneous nerve entrapment, rib-tip syndrome, myofascial pain, trigger points and rectus sheath hematomas.

The anterior rectus fascia is mobilized distally off the underlying rectus muscle bodies.

Note the very small incision in the rectus fascia, as compared to a traditional TRAM flap.

When compared to trophoblast culture, the p27 expression in levator ani muscles was lower, but higher then weak expression in whole placenta and rectus fascia.

Continuous monofilament suture closure of lateral edges of the rectus muscle to the anterior rectus fascia prevents hernia.

Closure is accomplished with 5 to 6 horizontal mattress sutures of permanent braided suture approximating the anterior rectus tendons to the intact distal anterior rectus fascia.

First, the inferior epigastric artery and vein (or veins) run superiorly on the posterior surface of the rectus abdominis, enter the rectus fascia at the arcuate line, and serve the lower part of the muscle.