. Operative surgery, for students and practitioners . terminal branches of the internalmammary, the superior epigastric, and the musculo-phrenic. Thesuperior epigastric is continued from the thorax, through the open-ing in the diaphragm, between its costal and sternal portions; itpierces the posterior layer of the sheath of the rectus, supplies thismuscle and gives off branches which perforate the muscle and theanterior layer of its- sheath to supply the subcutaneous tissue andskin of the abdomen. It anastomoses with branches of the superficialepigastric and deep (inferior) epigastric. Below,
. Operative surgery, for students and practitioners . terminal branches of the internalmammary, the superior epigastric, and the musculo-phrenic. Thesuperior epigastric is continued from the thorax, through the open-ing in the diaphragm, between its costal and sternal portions; itpierces the posterior layer of the sheath of the rectus, supplies thismuscle and gives off branches which perforate the muscle and theanterior layer of its- sheath to supply the subcutaneous tissue andskin of the abdomen. It anastomoses with branches of the superficialepigastric and deep (inferior) epigastric. Below, the deep epigastric and deep circumflex iliac, which arederived from the external iliac, are encountered; these are givenoff just before this vessel passes under Pouparts ligament to becomethe femoral. The deep epigastric is directed upward and inward toward theumbilicus, resting upon the posterior surface of the rectus, be-tween the transversalis fascia and the parietal peritoneum, andenters the substance of this muscle below the semilunar fold of. Fig. 91.—The Regions of the Abdomen as Indicated by Two TransverseLines drawn through the Tips of the Cartilages of the Tenth Ribs and theAnterior Superior Iliac Spines and Two Oblique Lines drawn from the Tipsof the same Cartilages down to the Pubic Spines. The liver and gall-bladderare indicated in orange, stomach and duodenum in red (dotted lines repre-sent that part of the duodenum which lies behind the stomach). The pan-creas and colon are indicated in blue, the kidneys in green. ABDOMEN. 229 Douglas, supplying it and anastomosing with the end branches ofthe superior epigastric. Some branches from this vessel pierce theanterior layer of the sheath of the rectus muscle and ramify in thefatty layer beneath the skin. The deep circumflex iliac passes upward and outward beneathand parallel with Pouparts ligament toward the anterior superioriliac spine; it then runs along the crest of the ilium and afterpiercing the transversalis f
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