. A manual of operative surgery . nnot in such case be avoided. The muscle very seldomextends beyond the lower third of the interval between thepubes and the umbilicus. The linea semilunaris may be represented by a slightlycurved line drawn from about the tip of the ninth costal car-tilage to the pubic spine. In the adult it would be placed aboutthree inches from the navel. The outline of the rectus can bewell seen when the muscle is in action. It presents three linege transversae, one usually opposite the xiphoid cartilage,one opposite the umbilicus, and a third between the two. Thetwo upper
. A manual of operative surgery . nnot in such case be avoided. The muscle very seldomextends beyond the lower third of the interval between thepubes and the umbilicus. The linea semilunaris may be represented by a slightlycurved line drawn from about the tip of the ninth costal car-tilage to the pubic spine. In the adult it would be placed aboutthree inches from the navel. The outline of the rectus can bewell seen when the muscle is in action. It presents three linege transversae, one usually opposite the xiphoid cartilage,one opposite the umbilicus, and a third between the two. Thetwo upper of these lines are the best marked. 90 ABDOMINAL OPERATIONS [PART II The linea semilunaris is now frequently used for openingthe abdomen— in operation on the gall-bladder, on thevermiform appendix, or in abdominal nephrotomy. Care shouldbe taken not to damage more than is absolutely necessarythe nerves which supply the rectus and which enter its outerborder (Fig. 32). The site of the umbilicus varies with the obesity of the. FIG. 32.—LINES OF INCISION FORE ABDOMINAL OPERATIONS. a, for removal of vermiform appendix (through sheath of rectus muscle) ; />, ditto (outsiderectus muscle) ; c, for operations on gall-bladder ; d, linea semilunaris ; e, line of deepepigastric artery ; f, incision for gastrostomy. The line above Pouparts ligament onthe left side marks the incision for radical cure of insruinal hernia. individual and the laxity of the abdomen. It is normallysituated from three-quarters of an inch to one inch above aline drawn between the highest points of the two iliac umbilicus is difficult to disinfect as regards its cutaneousfurrows, and special care should be taken to effect this. Some-times the umbilicus itself is excised, which makes accuratesuturing easier. As a rule, a vertical incision in this regionshould be carried to one side of the umbilicus. CHAP. I] ABDOMINAL SECTION 9i The only arteries of any magnitude in the abdominal wallsare the t
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