The aponeurosis is a wide tendon plate. It is made up of collagen and elastic fibers. In many ways, the peritoneal-perineal aponeurosis is similar to a normal tendon. The main difference is the absence of blood and nerve endings in its structure.

The structure and functions of the aponeurosis of the anterior abdominal wall

The muscles of the abdomen are formed from the muscles of the press. They, in turn, are divided into straight, oblique and transverse. Classification is carried out on the basis of the anatomical location of the muscle fibers in the anterior abdominal wall.

A feature of the aponeurosis is the fact that it even visually differs from the surrounding tissues. The tendon plate has a shiny, whitish-silver color. This structure contrasts against the background of red muscle fibers. Their color is caused by excellent blood supply and tissue nutrition, which perceive huge loads.

The main function of the aponeurosis is called muscle attachment. This structure plays an important role in ensuring the efficiency of the human motor apparatus. It envelops the abdominal muscles from all sides, which forms a reliable frame.

Internal oblique muscle

Participates in many important functions of the human body:

• body tilts to the sides;
• rotational movements;
• abdominal tension.

The internal oblique muscle also "forces" chest move down. It starts from the womb and ends near the costal arch. The direction of its fibers is downward from the iliac crest, in appearance it resembles a fan.

The internal aponeurosis on the opposite side is connected to the same structures, forming a reliable weaving to fix the muscle. It is also attached to the linea alba.

External oblique muscle

Directed from top to bottom. It is attached near the ribs, on the opposite side - at the iliac crest, pubic symphysis. The direction of the fibers is at a slight inclination relative to the axis.

The aponeurosis and tendons of the external oblique muscle form the white line of the abdomen. The width of this structure is variable, ranging from 0.5-2.5 cm. The white line is also formed by the internal oblique and transverse muscles.

In the center is a hole - the umbilical ring. In this zone, there is minimal motor activity of the skin. This is achieved by the presence of fasciae - jumpers formed from connective fibers.

Possible pathologies

A defect in the aponeurosis of the anterior abdominal wall is a common problem for surgeons, urologists, and gynecologists. Pathology is both congenital and acquired. Needs careful diagnosis for successful treatment.

If symptoms of aponeurosis of the external oblique muscle of the abdomen or a peritoneal-perineal defect appear, the patient must undergo a detailed examination. Such signs are also characteristic of muscle lesions with myofascial syndrome.

Reasons for the development of the problem

Aponeurosis defects are usually found among professional athletes - football players, hockey players, dancers. The appearance of inguinal pain is associated with microtrauma in the abdominal muscles. The development of the aponeurosis of the anterior abdominal wall occurs after operations:

• with an ectopic pregnancy;
• appendectomy;
• C-section.

The appearance of pathology after surgery is explained by the patient's non-compliance with the doctor's recommendations regarding the recovery period. A person too early exposes the body to intense physical activity or lifts weights. As a result, the cut fibers do not have time to recover, which most often leads to the formation of hernias.

The problem also arises with non-professional performance of surgical intervention. If the operation is performed to treat a hernia, a special mesh is applied to the weakened tissue area. It strengthens the abdominal wall. The mesh is installed "with a margin", overlapping healthy areas of the body. If its edge does not extend far enough, misalignment or inefficient performance may occur.

Symptoms

In the presence of a defect in the aponeurosis, pain occurs in the groin area, which is significantly aggravated by sudden movements. An increase in the severity of this symptom is observed when coughing, sneezing, during coups in bed, having sex, while climbing stairs.

Against the background of a violation of the integrity of structures from the connective tissue, hernial protrusions are formed. They are extremely dangerous for the patient's life, because they can be infringed. Without promptly started surgical intervention, everything ends in death.

Features of treatment

Therapy of aponeurosis defects in the abdominal wall in 95% of cases occurs surgically. The operation is performed to remove scarred tissue. The displaced area is moved to the desired anatomical position, which relieves the patient of pain. When the aponeurosis is ruptured, the surgeon performs restoration of its integrity.

Other methods of treatment are ineffective and do not completely eliminate the problem. With the development of the inflammatory process in the tissues, therapy is prescribed using the following medications:

• non-steroidal anti-inflammatory drugs;
• corticosteroids;
• intramuscular injections of anti-inflammatory drugs.

At the rehabilitation stage, in order to prevent the recurrence of defects, patients are advised to reduce physical activity and normalize their weight. Physiotherapy is used to restore tissue function. Patients receive massage special gymnastics, electrophoresis. After surgery, patients are advised to limit physical activity for a period of 4-6 months.

So muscles. On the right, I sketched a person. I want to talk about three types of muscles, and the drawing will help show exactly where each type of muscle is located. The word "muscle" implies the performance of any movement. Different types of muscles imply different types of movements. Let's start with something simple - with the movement of the foot. Let's show in the figure a muscle that is played in football. This is a large muscle that is connected to the bones of the skeleton. Here is the bone. Large bone, the largest in the body. Femur . The muscle is connected to it with the help of tendons, which are located at both ends. The tendon connects the muscle and bone, and the muscle moves the limb. It is a skeletal muscle because it connects to the bones of the skeleton. However, you should be aware that not every skeletal muscle is connected to bone. There are muscles that are not connected to tendons. This is where the external oblique muscle of the abdomen is located. You may not remember. The bottom line is that this part of the muscle is not connected to the tendon, but forms an aponeurosis. The aponeurosis is a flat fibrous structure. The human body is symmetrical and this aponeurosis is associated with a similar aponeurosis of the other half of the body, into which another external oblique muscle passes. It turns out that the external oblique muscle does not form a tendon, but an aponeurosis - a flat structure consisting of connective tissue. Now you know that not all skeletal muscles are connected to tendon and bone. Some of these muscles pass into the aponeurosis. Let's write it down. The bottom line is that you learn to recognize skeletal muscles. These are muscles familiar to everyone and everyone. Here I have listed the main features of skeletal muscles. So now you know them. What about two other types? What can be said about them? The cardiac muscle, as the name suggests, is located in the heart and only in the heart. This is the myocardium. The striated muscles of the cardiac type are found only in the heart. The heart contains special cells that differ from other muscle cells in structure and function. These are cardiomyocytes, they are only in the heart. I will write in this column where you can find different types of muscles. Now about smooth muscles. Where are they located? Yes, in any hollow organ. In all hollow organs and blood vessels. Not only in them, but the vast majority is located precisely in hollow organs and vessels. The same stomach can serve as an example of a hollow organ. I'll write down a couple of examples. This is, for example, the intestines. And the stomach, which has already been discussed. Inside all these organs there is a cavity. When it comes to blood vessels, think of the aorta, for example. The aorta leaves the heart. And the aorta is also a hollow organ. Between the walls of the vessel there is a cavity inside which blood flows. This is a hollow organ. Conceptually, a vessel is a hollow organ. And, as in hollow organs, there are smooth muscles in the vessels. Smooth muscles are found in the walls, in the walls of hollow organs, in the walls of blood vessels. Now we know where the different types of muscles are located. What about their function? The smooth muscles of the stomach push food further, the heart muscle pumps blood. This is an important feature. And skeletal muscles are used all the time to shake hands, to hug someone, to just move, to go somewhere. How else do they differ from each other? Let's talk about managing them. Who controls the movement of different types of muscles? Smooth muscles are responsible for involuntary movements that occur without conscious control by a person, automatically. The heart muscle also moves involuntarily and the heart acts automatically. Skeletal muscles are responsible for voluntary movements, that is, those that occur at the will of a person. A person controls all the movements of his limbs, for example. What about the speed of these movements? Which of these muscles are fast? So, the slowest are smooth muscles, the fastest are skeletal. Arbitrary movements and should be the fastest, and involuntary speed is not needed. And the heart muscle occupies an intermediate position in speed. That is, for example, the vessels expand and contract much more slowly than the movements of the arms and legs occur. When you catch a ball, thousands of skeletal muscles move very quickly. Skeletal - the fastest. And finally, let's talk about the structure of these muscles. Let's look at what cells different types of muscles are made of and what they look like. Smooth muscle cells look like this: they look like an eye or an almond bone. Very similar to the eye, left or right. The cage has a wide middle and thin ends. This shape is called spindle-shaped. Everyone knows this word, although no one has been using spindles for a long time. Every cell has a nucleus, this thing in the center, in the middle of the cell. This is how a smooth muscle cell looks like, in the heart muscle there are completely different cells. They have a very special shape. The cells of the heart muscle are branched, but not all. There are cells of the usual form. But it is the branched cells that are characteristic of the heart muscle. I'll erase this regular cell for clarity. Here is a branched cell - hallmark heart muscle. These cells have nuclei, sometimes one, sometimes two. That is, the principle "one cell - one nucleus" does not work in the heart muscle, although it is quite true for smooth muscle. That is, there are two distinguishing features: a branched form and the presence in some cells of not one, but two nuclei. And the nuclei are also in the middle of the cell. You will understand the difference when I draw the skeletal muscle. A skeletal muscle cell looks like this. She has such protrusions on the surface. These protrusions are intended for nuclei located on the periphery of the cell. And these cores are not one or two, there are many of them. Skeletal muscle is made up of giant multinucleated cells. And these cells are even in shape, without branching, elongated. They have many nuclei. This is a very important distinguishing feature of skeletal muscle: the presence of a large number of nuclei on the periphery of muscle cells. In cells of other types of muscles - in the middle. And under a microscope, the heart and skeletal muscles look striated. They are called cross-striped. But smooth muscles do not have such banding. Only the cardiac and skeletal muscles are striated. We saw transverse striation, know that it is cardiac or skeletal, but definitely not smooth muscle. Smooth muscle does not have such banding. This is a microscopic picture, and I will tell you about the reason for such banding in the next video. Now I want you to know what they look like and how they differ. Cardiac and smooth muscles have in common - they are involuntary. Skeletal and cardiac muscles are both striated. All three types of muscles are similar to each other, although they have a number of differences. Subtitles by the Amara.org community

105. 1- aponeurosis of the external oblique muscle of the abdomen is sewn edge to edge without tension;

2- Thomson's plate is sutured with separate vicryl sutures;

3- apply cosmetic skin sutures.

106. 1 - discharge of the hernial sac ;

2 - processing his neck .

107. 1 - plastic surgery of the inguinal canal according to Ru - T. P. Krasnobaev ;

2 - according to A.V. Martynov .

108. 1 - femoral ;

2 - inguinal .

109. 1- there is the possibility of visual control of the surgical field in order to prevent damage to the formations surrounding the femoral ring (femoral vein, obturator artery in the "crown of death", round ligament of the uterus, etc.).

110. 1 - the hernial orifice is closed by suturing the pectinate ligament to the inguinal ligament ;

2 - sometimes the previous method of hernioplasty is combined with suturing of the sickle-shaped edge fascia lata thigh to pectinate fascia .

111. 1 - in suturing the inguinal ligament to the pectinate ligament from the side of the inguinal canal .

112. 1 - there is an increase in the height of the inguinal gap (which creates the possibility of an inguinal hernia) .

113. 1 - according to Parlaveccio, the deep opening of the femoral canal and the inguinal gap are simultaneously closed, eliminating the possibility of the formation of a direct inguinal hernia in the future) ;

2 - after closing the deep femoral ring, the inguinal gap is eliminated by suturing the lower edges of the internal oblique and transverse muscles to the pectinate ligament .

114. 1 - vertical skin incision along the midline. They start a few cm above the navel, go around the navel on the left and continue the incision 3-4 cm down ;

2 - semilunar incision bordering the hernial protrusion from below .

115. 1 - the deformed navel is excised in agreement with the patient .

116. 1 - the imposition of a purse-string suture on the edges of the umbilical ring in the longitudinal direction under the control of a finger inserted into the umbilical ring .

117. Creation of duplication due to sheets of the white line of the abdomen

1 - a skin incision is made along the midline of the abdominal wall, bordering the hernial protrusion. Open (for the purpose of revision) and remove the hernial sac. The umbilical ring is expanded up and down to full tissues. Scar-modified areas of the white line are sparingly excised. After careful hemostasis, doubling of the aponeurosis ("white line") ;

2 - the left edge of the aponeurosis is retracted to the left and the right edge is sutured to its base, the free left edge of the aponeurosis is placed over the right edge and sutured with separate sutures .

118. The principle of the operation is to create a duplication of anoneurosis in the area of ​​the umbilical ring ;

1 - the umbilical ring is dissected with a horizontal incision. The lower edge of the incision of the aponeurosis with "P"-shaped sutures is moved under the upper ;

2 - the free upper edge of the incision of the aponeurosis is placed on the lower one and fixed with the second row of sutures .

119. 1 - violation of the blood supply to the organ, followed by gangrene and the development of peritonitis ;

2 - in the deep opening of the inguinal canal ;

3 - in the superficial opening of the inguinal canal .

120. 1 - produce normal for operations inguinal hernias skin and subcutaneous incision basics ;

2 - after dissection, the aponeurosis of the external oblique muscle of the abdomen is isolated from the hernial sac ;

3 - open the hernial sac, fix the strangulated organ ;

4 - after which the infringing ring is dissected - most often the aponeurosis of the external oblique muscle of the abdomen. Less often, infringement occurs in the internal opening of the inguinal canal. The strangulated organ is covered with napkins soaked in warm saline and observed for 5-7 minutes. If after this time the restrained part of the organ has not acquired signs of vital activity, it is resected. The further stages of the operation are the same as for an unstrapped hernia. .

121. 1 - up and ;

2 - laterally .

122. 1 - in the medial direction ;

2 - lacunar ligament ;

3 - obturator artery in the "crown of death" .

123. 1 - “laparotomy” or “ventiotomy” - opening of the abdominal cavity (“relaparotomy” - re-opening of the abdominal cavity) ;

2 - therapeutic (laparotomia vera) - operational access to the abdominal organs in order to perform an operative reception ;

3 - diagnostic, trial (laparotomia probatoria).

124. 1 - longitudinal ;

2 - oblique ;

3 - corner ;

4 - transverse ;

5 - combined .

125. In relation to the midline and the rectus abdominis muscle, the following incisions are distinguished :

1 - median ;

2 - paramedian ;

3 - transrectal ;

4 - pararectal .

126. 1 - median incision .

127. 1 - upper midline laparotomy ;

2 - lower midline laparotomy .

128. 1 - provide wide access to the organs of the abdominal cavity (beneficial in emergency operations for acute surgical diseases of the abdomen and penetrating wounds) ;

2 - blood vessels and nerves of the anterior-lateral abdominal wall are not damaged ;

3 - the incision can be widened up and down ;

4 - slow scar formation ;

5 - wound dehiscence in debilitated patients.

129. 1 - in order to exclude damage to the umbilical vein located in the round ligament of the liver (the ligament is directed from top to bottom, from right to left, from back to front). If necessary, hemostatic clamps are applied to the ligament, dissected between them and bandaged.

130. 1 - the medial edge of the rectus abdominis muscle is displaced to the lateral side ;

2 - the lateral edge of the rectus abdominis muscle is displaced to the medial side .

131. 1 - the rectus abdominis is not damaged ;

2 - the line of incisions of the anterior and posterior walls of the aponeurotic sheath of the rectus muscle is not coincide ("step-like" access) ;

3 - there is a prerequisite for damage to the branches of the intercostal nerves located on the back wall of the vagina to the rectus muscle. V. I. Dobrotvorsky modified the Lennander operative approach: the posterior wall of the sheath of the rectus abdominis muscle is cut not vertically, but obliquely - in the direction of the intercostal nerves .

132. 1 - delaminate along the fibers in the longitudinal direction ;

2 - due to damage to the branches of the intercostal nerves that innervate the muscle .

133. 1 - liver ;

2 - ;

3 – spleen.

134. 1 - caecum c ;

2 - appendix ;

3 - sigmoid colon .

135. 1- oblique - along the fibers of the aponeurosis of the external oblique muscle of the abdomen (parallel to the inguinal ligament) ;

2 - variable - changing the direction of the operative approach, taking into account the course of the fibers of the internal oblique and transverse abdominal muscles ;

3 - the edges of the internal oblique and transverse muscles are bred stupidly with Farabef hooks (as the backstage is opened). The transverse fascia and parietal peritoneum are dissected in the transverse direction .

136. 1 - the layers of the anterior-lateral abdominal wall are separated along the fibers of the aponeurosis and muscles, i.e. in different directions. When suturing the wound, the lines of connection of the layers of the abdominal wall will not match. ;

2 - blood vessels and nerves are not damaged ;

3 - the incision ensures minimal wound depth;

137. 1 - limited visibility of the surgical field .

138. 1 - S. P. Fedorov. An incision along the midline, (3-5 cm from the xiphoid process down), then parallel to the right costal arch, 3-4 cm away from it, cross the rectus abdominis muscle ;

2 - T. Kocher. The incision is parallel to the right costal arch and 2 cm down from it .

139. 1 - Mack - Burney, N. M. Volkovich - P. I. Dyakonov. Oblique variable rocker cut ;

2 - Lennander (modified by V. I. Dobrotvorsky). Right-sided pararectal incision with a dissection of the posterior wall of the vagina of the rectus abdominis muscle in an oblique direction .

140. 1 - for transverse incisions above the navel, the rectus abdominis muscles are pulled to the sides (if necessary, the rectus muscles can be dissected in the transverse direction).

141. 1 - Pfannenstiel ;

2 - skin ;

3 - subcutaneous tissue ;

4 - superficial fascia ;

5 - white line of the abdomen ;

6 - transverse fascia ;

7 - preperitoneal tissue ;

8 - parietal peritoneum .

142. 1 - liver ;

2 - gallbladder (and extrahepatic bile ducts) ;

3 - spleen .

143. 1 - cardia of the stomach ;

2 - abdominal part of the esophagus .
3 -liver.

144. 1 - the parietal peritoneum in the middle of the wound is captured with two anatomical tweezers, a fold is formed, which is dissected with scissors. The edges of the peritoneal incision, together with the overlaying towels, are grasped with Mikulich clamps. The peritoneum is dissected along the entire length of the wound, lifting it with the index and middle fingers of the left hand, inserted into abdominal cavity .

145. 1 - lamellar hooks (Farabefa) ;

2 - mechanical retractor ;

3 - first, closed fingers are inserted into the abdominal cavity. Hooks (retractor) inserted between the abdominal wall and fingers .

146. 1 - as a hemostasis ;

2 - in the absence of a foreign body in the abdominal cavity .

147. 1- three ;

2 - peritoneal suture ;

3 - suture of the aponeurosis (white line of the abdomen);

4 - skin suture (with subcutaneous base) .

148. 1 - preperitoneal tissue ;

2 - transverse fascia ;

3 - continuous twisting (Reverden-M.P. Multanovsky) ;

4 - catgut .

149. 1 - from the bottom ;

2 - Reverden's spatula (a silver tablespoon, or a napkin, which is removed before the wound is completely closed) ;

3 - the edges of the aponeurosis are first brought together with several strong silk sutures .

150. 1 - knotted silk ;

2 - continuous wrapping (or continuous mattress). Continuous aponeurosis sutures have an advantage over nodal sutures, since they disrupt tissue trophism less. General requirement for the suture of the aponeurosis is thoroughness in comparison of edges, excluding fat interposition (V. M. Buyanov et al., 1993) .

3 - in recent years, most surgeons for the suture of the aponeurosis recommend absorbable monofilaments: maxon, polydioxanone.

151. 1 -elimination of cardiovascular and respiratory failure by removing ascitic fluid ;

2 - in the midline of the abdomen, midway between the umbilicus and the pubis ;

3 - to exclude damage to the bladder and the occurrence of urinary peritonitis .

152. 1 - to facilitate the introduction of the trocar (the skin is sclerosed!);

2 - perpendicular to the surface of the skin of the abdomen .

153. 1 -the liquid is removed in portions, periodically closing the opening of the trocar. To prevent a sharp decrease in intra-abdominal pressure due to the removal of fluid, the anterior abdominal wall is squeezed with a towel or sheet. .

154. 1 - pubic tubercle ;

2 - spermatic cord ;

3 - round ligament of uterus .

155. 1 - imposition of pneumoperitoneum (2500-4500 ml of air is injected through sterile cotton wool with a Janet syringe with a capacity of 150-200 ml under the control of intra-abdominal pressure, which should be 6-8 mm Hg) ;

2 - puncture of the abdominal cavity with a trocar and insertion of a laparoscope ;

3 - examination of the abdominal organs ;

4 - point on the border of the middle and lower third of the right spinous-umbilical line ;

5 - 2 transverse fingers to the left of the midline and above the navel ;

6 - 2 fingers below the navel near the midline .

156. 1 - organs are examined in a certain order - an approximate examination begins from the upper right quadrant and, moving clockwise, returns to its original place. After that, all attention is concentrated on the suspicious area. Inspection is performed not only in the horizontal position of the patient, but also in other positions, which greatly expands the diagnostic capabilities of this method. After the study, air is released. Stitches are placed at the laparocentesis site. .

Gynecologists, urologists, surgeons periodically face such a problem of their patients as inguinal pain. Timely and correct diagnosis of the causes of their occurrence is the key to successful treatment. Studies show that in more than 20% of cases, the cause of inguinal pain is a defect in the aponeurosis of the NCMF (external oblique abdominal muscles).

In most cases, this problem is considered from the angle of sports pathology, in professional football players, hockey players, as well as ballet dancers. For the first time mentions of inguinal pain in athletes appeared in the second half of the last century. The occurrence of such pain was associated with the pathology of the adductor muscles of the thigh and microtrauma of the muscles of the anterior abdominal wall, mainly the rectus abdominis.

In the 90s of the last century, even the special term "athlete's hernia" was introduced, which describes the weakness or violation of the integrity of the posterior wall of the inguinal canal. Gilmor describes a triad of symptoms: rupture of the aponeurosis of the external oblique muscle leading to expansion of the external inguinal ring, rupture of the inguinal falx, and gaping between the inguinal ligament and inguinal falx.

However, among patients with inguinal pain, there are also patients with an acquired defect in the NCCM aponeurosis as a result of a previous appendectomy or surgery for ectopic pregnancy.

- a defect of a linear nature - the inclusion in the region of the defect of the terminal branches n. iliohypogastricus - “muscular hernia” - fibers of the internal oblique muscle of the abdomen protruding into the defect area - an anomaly in the development of the inguinal sickle, when there are almost no tendon fibers in this area.

Typical complaints in patients with defects in the aponeurosis are groin pain, worse after sudden movement, such as hitting a ball, turning in bed, coughing or sneezing, during sex and when climbing stairs. The complexity of diagnosis lies in the ambiguous interpretation of the ultrasound study in the study of pathology in this area.

And this is precisely the reason for all unsuccessful attempts at conservative treatment of this kind of inguinal pain by specialists who do not have the necessary qualifications and experience. surgical treatment aponeurosis defects. However, these specialists can and should suspect such a problem in the absence of demonstrative symptoms of a gynecological or urological disease, or in the absence of long-term unsuccessful treatment of such.

According to our results of surgical treatment of NCCM aponeurosis defect in 54 patients, all patients noted complete (52 patients or 96.3%) or almost complete (2 patients or 3.7%) disappearance of pain and restoration of motor functions, which were impaired due to pain syndrome. In most cases, after the operation, no special rehabilitation methods were required, except for exercise therapy.

Close interaction of gynecologists, urologists, surgeons with a specialist in the treatment of inguinal pain and early diagnosis of the causes of their occurrence is the key to successful treatment and early rehabilitation with the restoration of all motor functions. And most importantly - getting rid of the patient from constant pain.

The muscles of the abdomen are formed from the muscles of the press. They, in turn, are divided into straight, oblique and transverse. Classification is carried out on the basis of the anatomical location of the muscle fibers in the anterior abdominal wall.

A feature of the aponeurosis is the fact that it even visually differs from the surrounding tissues. The tendon plate has a shiny, whitish-silver color. This structure contrasts against the background of red muscle fibers. Their color is caused by excellent blood supply and tissue nutrition, which perceive huge loads.

Participates in many important functions of the human body:

• body tilts to the sides;
• rotational movements;
• abdominal tension.

The internal oblique muscle also "forces" the chest to move down. It starts from the womb and ends near the costal arch. The direction of its fibers is downward from the iliac crest, in appearance it resembles a fan.

The internal aponeurosis on the opposite side is connected to the same structures, forming a reliable weaving to fix the muscle. It is also attached to the linea alba.

Directed from top to bottom. It is attached near the ribs, on the opposite side - at the iliac crest, pubic symphysis. The direction of the fibers is at a slight inclination relative to the axis.

The aponeurosis and tendons of the external oblique muscle form the white line of the abdomen. The width of this structure is variable, ranging from 0.5-2.5 cm. The white line is also formed by the internal oblique and transverse muscles.

In the center is a hole - the umbilical ring. In this zone, there is minimal motor activity of the skin. This is achieved by the presence of fasciae - jumpers formed from connective fibers.

A defect in the aponeurosis of the anterior abdominal wall is a common problem for surgeons, urologists, and gynecologists. Pathology is both congenital and acquired. Needs careful diagnosis for successful treatment.

If symptoms of aponeurosis of the external oblique muscle of the abdomen or a peritoneal-perineal defect appear, the patient must undergo a detailed examination. Such signs are also characteristic of muscle lesions with myofascial syndrome.

Aponeurosis defects are usually found among professional athletes - football players, hockey players, dancers. The appearance of inguinal pain is associated with microtrauma in the abdominal muscles. The development of the aponeurosis of the anterior abdominal wall occurs after operations:

• with an ectopic pregnancy;
• appendectomy;
• C-section.

The appearance of pathology after surgery is explained by the patient's non-compliance with the doctor's recommendations regarding the recovery period. A person too early exposes the body to intense physical activity or lifts weights. As a result, the cut fibers do not have time to recover, which most often leads to the formation of hernias.

The problem also arises with non-professional performance of surgical intervention. If the operation is performed to treat a hernia, a special mesh is applied to the weakened tissue area. It strengthens the abdominal wall. The mesh is installed "with a margin", overlapping healthy areas of the body. If its edge does not extend far enough, misalignment or inefficient performance may occur.

Depending on the location of the lesion, diagnosis can be complicated and should be carried out by several specialists at the same time. To establish the diagnosis, an ultrasound, x-ray is prescribed.

Plantar aponeurosis, palmar, epicranial, and abdominal muscles require surgical intervention in 95% of cases.

taking non-steroidal anti-inflammatory drugs, corticosteroids, intramuscular injections.

Recovery motor ability arms, legs, abdominal wall, head and neck, physiotherapy is prescribed at the rehabilitation stage: massage, electrophoresis, gymnastics.

Physiotherapy does not stop even after the patient has fully recovered and is carried out regularly as a preventive measure.

is carried out in order to remove the healed area of ​​the fascia and give an anatomically correct position to the damaged surface.

If the aponeurosis is the result of tissue rupture, then the surgeon will restore the integrity of the tendon plate.

As a result of surgery, a person may lose his ability to work for the recovery period - up to 4-6 months.

According to the classification of the prolapse of the tissues of the anterior abdominal wall (abdominoptosis) in the standing position according to A. Matarasso, the following degrees are distinguished:

I degree (minimum) - stretching of the skin without the formation of a skin-fat fold;

II degree (medium) - the formation of a small skin-fat fold, which clearly hangs down in the "diver" position;

III degree (moderate) - skin-fat apron within the flanks, hanging down vertical position, "pinch" less than 10cm;

IV degree (expressed) - skin-fat apron within lumbar region, "pinch" more than 10 cm, combined with skin-fat folds in the subscapularis.

Diastasis (divergence) of the rectus abdominis muscles is the weakening and expansion of more than 2 cm of the white line, which leads to an increase in the distance between the rectus abdominis muscles. The indication for surgery is the expansion of the white line by more than 4 cm. Externally, muscle diastasis manifests itself as a longitudinal bulge-like bulge along the midline in the middle and upper abdomen with tension of the rectus muscles and an increase in intra-abdominal pressure.

A hernia of the anterior abdominal wall is a chronically developing defect in the muscular-aponeurotic complex of the abdomen with the release of organs from the abdominal cavity without depressurization. A hernia looks like a protrusion on the surface of the abdomen, while there may be a feeling of discomfort, pain in its area when walking, running and other physical exertion.

By origin, hernias are congenital and acquired (primary, postoperative, recurrent). The causes of hernia disease and weakening of the white line are a combination of factors, the main of which is an increase in intra-abdominal pressure (physical activity, frequent cough and chronic constipation, pregnancy, etc.).

• oblique muscle of the abdomen;
• transverse abdominal muscle.

Aponeurosis of the palm

The palmar aponeurosis is the strands that cover the surface of the palm of the human hand. When a pathology such as Dupuytren's contracture is detected in a patient, this often indicates the fact of an anomaly of the tendon plate. A person with such a problem has a cicatricial contraction of the aponeurosis, which occurs due to the formation of nodes, strands on it. That is why contracture appears, due to which the finger (or several) is constantly in a bent position.

As a rule, the palmar aponeurosis is found in men, but the cause of its occurrence is still unknown. Most experts are of the opinion that hand injuries provoke pathology, but in this case, by the age of forty, everyone would have such a contracture. The disease progresses slowly, over time affecting both hands.

The only thing effective treatment- an operation involving the excision of the palmar aponeurosis. If we consider other serious anomalies of the upper limbs of this type, then no less problems are caused by the pathology of the biceps muscle of the shoulder, against which shoulder joints also lose their normal functions.

head injury

Traumatic brain injuries are very common in humans. However, it is often believed that if the skull is not broken or there is no concussion, then nothing serious has happened. However, during a blow to the head, damage to the tendon helmet is possible (this is how the aponeurosis of the head is called), as a result of which a rather large hematoma is often formed, resembling a dent in the skull.

With such an anomaly, a person feels a very strong pain, and the hematoma itself has a dark red color, then it turns blue, then turns green, and at the final stage it turns yellow. These metamorphoses are associated with the breakdown of hemoglobin accumulated in the area of ​​hemorrhage.

The supracranial aponeurosis (this is the second designation of the tendon helmet, which resembles a helmet in its shape) connects the frontal, occipital, and supracranial muscles into one whole. It is attached to the skin above the nose, eyes and is very important for the implementation of facial expressions (for example, it helps to raise eyebrows, wrinkle the skin of the forehead).

Foot ailments

If we consider the plantar aponeurosis, then it should be noted that this is a common pathology of runners or people who love long walks. Inflammation in the area of ​​​​the heel and sole is associated with the plantar aponeurosis. Often, the disease manifests itself in people of age, as well as in those who, due to professional duties, spend all day on their feet. The main symptom of the problem is pain in the heel, which worries when the load on the lower limbs and at complete rest.

Doctors explain the problem as follows: normally, the aponeurosis acts as a shock absorber, supporting the arch of the foot, but with excessive load, microcracks and microruptures form in this tendon plate, the healing of which takes quite a long time. It is these injuries that cause pain in case of non-compliance with the regime of work and rest, as well as in the process of professional running.

In almost all cases of such an ailment, the only effective treatment is surgery (dissection, resection, removal of the pathological site). Only in some cases it is possible to use conservative methods of treatment. Self-medication in such cases is not at all permissible.

The cause of the pathology is a defect in the connective tissue. The fact is that it is depleted and expands, which causes the appearance of slit-like holes. In children, the main factor in the development of education is the physiological hypoplasia of the aponeurosis.

The cause of the pathology is a defect in the connective tissue. The fact is that it is depleted and expanded, and this causes the appearance of slit-like holes. In children, the main factor in the development of education is considered to be physiological underdevelopment and weakness of the aponeurosis.

In general, the main reasons that have a negative impact on the condition of the connective tissues of the white line of the abdomen include:

• hereditary predisposition;
• abdominal trauma;
• excessive body weight;
• surgical operations on the abdominal organs.

It is worth noting that the weakening of the muscles and tissues of the abdomen is not always a factor in the development of the disease. In some cases, a hernia appears due to increased intraperitoneal pressure. This occurs when:

• chronic constipation;
• pregnancy;
• difficult natural childbirth;
• weight lifting;
• physical stress;
• strong cough;
• difficult urination;
• strong and prolonged crying in infants.

Most often, the disease develops in men under the age of 30, and in women 40-50 years old, but it can also affect women.

Education may be supra-umbilical. In this case, a hernia occurs above the navel. Formed in 80% of cases. Paraumbilical hernias are located near the navel and are observed in 18% of cases of hernia of the white line of the abdomen. The most rare are sub-umbilical hernias, which are diagnosed in only 2% of all cases.

Symptoms of the disease

With the development of a hernia of the white line of the abdomen, the symptoms may not disturb the patient for a long time. The main sign of pathology is the appearance of a bulge in this area, when pressed, discomfort and even pain often appear. In some cases, the formation is reduced, and it also disappears in a horizontal position on the back. If this does not happen, then the hernia is called irreducible and there is a high risk of infringement.

The main symptoms of an uncomplicated hernia include:

1. Nausea that is not related to eating errors. In some cases, turning into vomiting.
2. The presence of a painful or painless soft protrusion in the area of ​​the white line of the abdomen.
3. Formation of muscle strain along the midline.
4. Pain in the abdomen, which most often occurs after eating.
5. The occurrence of pain and discomfort when walking, sudden movements, bending or turning.
6. The appearance of symptoms such as hiccups, heartburn or belching.
7. On palpation in the region of the white line, a hole is clearly felt, which is called the hernial ring.

With a strangulated hernia of the white line of the abdomen, the following symptoms may be added to the above symptoms:

• vomiting torments constantly;
• the presence of blood in the stool;
• pain in the abdomen is constantly present and becomes unbearable;
• painful formation in the hernia.

A strangulated hernia requires immediate hospitalization for surgical treatment for surgical intervention. This condition occurs when the contents of the hernia are compressed by the hernial orifice. In this regard, a person constantly feels pain, therefore, immediate elimination of the pathology is required.

Diagnostics

To diagnose the pathology, you must contact the surgeon. In addition to a visual examination of the patient, taking an anamnesis and palpation of the abdomen, an additional examination may be prescribed. The most effective methods for diagnosing the disease include:

• x-ray of the stomach and duodenum with contrast;
• gastroscopy;
• computed tomography of the abdominal cavity.

Usually, the diagnosis is not difficult, the doctor needs a simple examination. The hernia is clearly visible, it can be palpated, as well as the contents of the hernial sac. IN difficult situations additional methods are being used. In case of infringement, the diagnosis is reduced to a minimum, since the patient's life is at stake.

Treatment of the disease

With the appearance of a hernia of the white line of the abdomen, treatment is reduced only to an operation with plastic hernia gate. This is the best method of eliminating the problem, allowing you to forget about the disease once and for all. Modern surgery offers several types of surgical correction of a hernia, each of which has a number of advantages and is prescribed for certain indications. Among them:

1. Use of synthetic mesh. Aponeurosis defect is corrected with a special mesh, which is made of non-toxic and hypoallergenic materials. First, the defect of the rectus muscles is excised, after which the hole is closed with a special mesh. Thus, the risk of recurrence of pathology is minimal. The mesh can be made from a material that is completely absorbable, or it can be preserved, gradually overgrown with tissues. The question of using such an auxiliary object is decided after assessing the condition of the patient's muscles. Therefore, most often such a decision is made during the operation.
2. Use of patient tissues. This operation consists in removing the diastasis of the muscles and suturing the hernial ring. The main disadvantage is the high risk of recurrence.
3. A strangulated hernia of the linea alba is treated surgically, and may include a large area of ​​resection.

There are several methods of surgical intervention, the choice of which depends on the individual characteristics of the patient and the course of the disease. These methods include:

• open operation. It consists in making an incision, the length of which corresponds to the size of the protrusion. This method rarely performed due to long postoperative care and the likelihood of complications;
• laparoscopic surgery. During the use of this method, three small punctures are made through which instruments and video surveillance are introduced;
• preperitoneal surgery. It is carried out through small punctures with the help of special tools and video surveillance. The difference of this method is the absence of the need for penetration into the abdominal cavity. There is a detachment of the peritoneum by introducing a balloon-dissector with gas.

Treatment of a hernia is impossible without surgery. There are methods that help slow down the development of pathology, but sooner or later the hernia will be infringed. Conservative methods include a bandage that slows down the process of defect expansion. However, it can become a substitute for surgical intervention only if such a patient is contraindicated. Surgery for surgical treatment of a hernia is contraindicated:

• during pregnancy;
• with severe cardiovascular pathology;
• in the presence of an acute focus of infection in the body;
• cancer patients;
• people suffering from kidney and liver failure.

If the operation is not possible, the only way to relieve pain is to take antispasmodic drugs - they eliminate muscle tension and the contents “leave” into the abdominal cavity. Taking painkillers can disrupt the clinical picture, complicate the diagnosis in case of infringement. However, they will not get rid of the main problem, but will only improve the condition for a while. Therefore, in the case when there are no contraindications, it is recommended to agree to surgical treatment.

Symptoms of a hernia of the Spigelian line of the abdomen

1. Predisposing. The conditions that create conditions for the formation of a hernia include congenital defects of the Spigelian line, traumatic injuries and operations on the abdominal cavity, a decrease in muscle extensibility against the background of aging of the body.
2. Producing. These factors cause a prolonged increase in intra-abdominal pressure and weakening of the abdominal muscles. These include excessive physical activity, weightlifting, chronic constipation, frequent hacking cough as a result of smoker's bronchitis and other lung diseases, ascites, overweight. Multiple pregnancy and severe protracted labor contribute to the weakening of the muscles of the Spigelian zone, a sharp jump in pressure in the abdominal cavity during attempts.

Not only parents went through the diagnosis of “umbilical hernia in a child”. And for each baby, the story with this sore ended in its own way, and for some, unfortunately, it has not been resolved so far. The prevalence and popularity of this pathology, but the low level of objective awareness of parents and susceptibility to rumors, often lead to a frivolous attitude and postponing treatment to the “far shelf”.

An umbilical hernia is a hole in the aponeurosis (its defect) of the navel, through which the abdominal organs exit.

In other words, the hernia exits through the umbilical ring.

An umbilical hernia is divided into 2 types, depending on when it appeared in a child: it was already at birth (congenital) or appeared in the process of growth and development (acquired).

Congenital is found even in the maternity hospital: in the area of ​​​​attachment of the umbilical cord, a wide spherical protrusion is clearly visible, which increases with a cry.

The causes of an acquired hernia can be: congenital weakness of the aponeurotic tissue (there is a hereditary predisposition for the formation of hernias), a prolonged increase in intra-abdominal pressure as a result of various diseases(bronchitis, whooping cough, constipation, phimosis, whooping cough)

Firstly, this should be done by a pediatric surgeon. Such a diagnosis may be made at his first examination after birth, or at one of his regular examinations during preschool or school age. It all depends on how the hernia formed and when it formed. If you yourself want to verify the presence of a hernia or suspect its presence, then the detection of one of the following criteria should prompt you to consult a doctor.

1. The presence of a tumor-like soft protrusion in the navel, or "increase in size" of the navel. By itself, a hernia in this area can have a different size and shape. It depends on how big the hole in the aponeurosis is. Also, the size of the hernia can increase with an increase in intra-abdominal pressure (lifting weights, after feeding), and then return to the original.
2. The found protrusion can completely go away, hide in the lying position of the child and appear standing up, with physical activity or straining.
3. In the area of ​​the detected hernia, if it is set, you can find a hole of various sizes through which it exits. This is the so-called defect in the aponeurosis.
4. Sometimes the baby may complain of pulling pains or just discomfort in the navel, but this may not be the case.
5. The child often has so-called intestinal colic, which disappear on their own or after the use of antispasmodic drugs (no-shpy).

In some cases, an umbilical hernia in a baby can be combined with a divergence (diastasis) of the rectus abdominis muscles.

Diagnostics

The surgeon makes a diagnosis on the basis of examining the child, feeling the umbilical region, determining the size of the hernia, aponeurosis defect and, if possible, the contents of the hernial sac (what organs come out). Most often, the contents are the omentum or the small intestine, and the doctor distinguishes them by the presence or absence of characteristic intestinal rumbling. Children are examined in two positions: standing (if they can already stand), straining, and lying down.

In the presence of an umbilical hernia, the child may not present any complaints. In this connection, parents often believe that it is not necessary to treat it.

It is believed that up to 1 year from the moment of birth, the hernial opening can heal on its own, which is associated with a high regenerative capacity of tissues (the ability to self-repair and heal). But this is only possible if the hernia is kept in a permanently reduced state, preventing organs from entering the hernial sac.

This can be achieved with the help of special hypoallergenic patches, bandage or other devices. Such tightening patches are applied by a pediatric surgeon only after the umbilical wound has completely healed (not earlier than 7 days). In addition, before feeding, the child must be laid out on the tummy so that the air that collects in the stomach comes out, and after food enters it, intra-abdominal pressure does not increase.

If the conservative methods used were ineffective, then the baby is prescribed surgical treatment, leading to a complete recovery. In this case, the navel is not removed, but on the contrary, after the operation it has an even more aesthetic appearance.

In order to understand the need for hernia treatment, it is necessary to be aware of the complications that may arise when it is present.

1. Infringement of a hernia. When a hernia is infringed, those organs that are in the hernial sac are compressed. After compression, the blood stops flowing to these organs and after a short period of time their necrosis (necrosis) occurs, which subsequently requires not only a hernia repair, but also the removal of dead sections of the intestine or omentum. That is why in case of pain in a child in the area of ​​a hernia, the appearance of its irreducibility, it is necessary to immediately contact the surgeon in the emergency room or call an ambulance team.
2. Coprostasis, constipation. Occurs more often if a hernia is sufficient large sizes and contains intestinal loops.

That is why it is necessary to engage in active treatment of a hernia from the moment it is discovered. After all, who, if not us, will take care of the health of our children.

The white line of the abdomen (linea alba) is formed by bundles of fibrous fibers of straight aponeuroses that are tightly adjacent to each other. abdominal muscles. It runs in the form of a flat thickened tendon strip along the midline of the abdomen from the xiphoid process of the sternum through the navel to the pubic joint. The width of the white line of the abdomen is normally 1-2.5 cm, below the navel it narrows to 0.2-0.3 cm.

A hernia of the white line of the abdomen is formed when the bundles of the aponeurosis diverge and protrude through the formed peritoneal defect and internal organs- intestinal loops and omentum. With the formation of a hernia of the white line of the abdomen, the divergence of the tendon fibers can reach cm. Hernial gates can be round, oval or diamond-shaped, more often they are relatively narrow - up to 5-6 cm, thereby increasing the risk of hernia incarceration.

Factors leading to a weakening of the connective tissue of the white line of the abdomen can be hereditary predisposition, obesity, abdominal trauma, scars after surgery. Provoke the formation of a hernia of the white line of the abdomen can also be situations associated with a sharp increase in intra-abdominal pressure - physical effort, pregnancy, difficult childbirth, constipation, ascites;

At the first stage, preperitoneal tissue comes out through a slit-like defect in the tendon fibers with the formation of a preperitoneal lipoma. At the initial stage, a hernial sac is formed, the contents of which are part of the omentum or a section of the small intestine. At the stage of a formed hernia, all components of the disease are present - a hernial orifice, a hernial sac with hernial contents, which may include an omentum, loops of the small intestine, an umbilical-hepatic ligament, a transverse colon, and a stomach wall. At the stage of final formation, the hernia of the white line of the abdomen is well defined visually and by palpation.

A hernia of the white line of the abdomen rarely reaches a large size, sometimes the process stops at the stage of preperitoneal lipoma: the protrusion does not protrude beyond the white line, is hidden and does not progress further.

According to the level of location relative to the navel, the following types of hernia of the white line of the abdomen are found:

• supraumbilical (epigastric, epigastric) - are formed above the navel, are most common (80%)
• paraumbilical (paraumbilical) - located near the umbilical ring (1%)
• subumbilical (hypogastric) - located below the navel (9%)

More often, hernias of the white line of the abdomen are single, less often - multiple, located one above the other.

The soreness of the formation increases after eating, during exercise, and other situations associated with an increase in intra-abdominal pressure. The tension of the omentum fixed to the hernial sac, the pressure of the parietal peritoneum on the nerves, or the temporary infringement of the hernia can contribute to increased pain. Pain with a hernia of the white line of the abdomen may be accompanied by irradiation in the hypochondrium, scapula, lower back.

Infringement occurs with a sudden compression of the elements of the hernial contents in the hernia gate. In this case, there are sharp, rapidly growing pains in the abdomen, nausea and vomiting, retention of stools and gases, blood in the stool, hernia unreduced by lightly pressing the hand in the supine position.

To clarify the anatomical structures involved in the hernial process, radiography of the stomach with barium, gastroscopy (esophagogastroduodenoscopy), ultrasound of the hernial protrusion, and MSCT of the abdominal organs are performed. In some cases, herniography is performed - an X-ray contrast study of a hernia.

Differential diagnosis of a hernia of the white line of the abdomen is carried out with peptic ulcer of the stomach and duodenum, pancreatitis, cholecystitis.

A feature of the surgery of hernias of the white line of the abdomen is the need for mandatory elimination of diastasis of the rectus abdominis muscles. Depending on the methods of surgical treatment for hernias of the white line of the abdomen, plastic with local tissues (tension) or synthetic prostheses (non-tension) can be used.

In the upper two-thirds of the rectus muscle, the anterior wall of the vagina is formed by the bundles of the aponeurosis of the external oblique muscle and the anterior plate of the aponeurosis of the internal oblique muscle; the back wall is the posterior plate of the aponeurosis of the internal oblique muscle and the aponeurosis of the transverse abdominal muscle. In the lower third of the rectus aponeurosis of all three muscles pass to the anterior wall of the vagina.

The aponeuroses of the posterior lumbar region cover the longitudinal muscles of the lower back: the muscle that straightens the body (lat. m. erector spinae) and the multifidus muscle (lat. m. multifidus)

Palmar aponeuroses cover the muscles of the palmar surface of the hands.

The supracranial aponeurosis, or tendon helmet (Latin galea aponeurotica) is an aponeurosis located between the skin and the periosteum and covering the cranial vault; is an integral part occipital-frontal muscle, uniting its occipital and frontal abdomen.

METHOD FOR REPLACING ABDOMINAL WALL APONEUROSIS DEFECT

The invention relates to medicine, namely to surgery, and can be used for the treatment of ventral hernias of large areas.

Ventral hernias in the meso- and hypogastric regions are a frequent complication after emergency and elective surgeries. According to M.S. Deriugina after obstetric and gynecological operations, they occur in 53.8% of patients, and relapses according to B.A. Barkov and N.I. Shpakovsky from 32-60% of cases.

A known method of plastic defect of the aponeurosis of the anterior wall of the abdominal cavity according to Mayo, which consists in creating a duplication in the transverse direction (Borodin I.F., Skobey E.V., Akulik V.P. Surgery of postoperative hernias of the abdomen. - Minsk, "Belarus", 1986 , pp. 49 and 50).

However, due to the inferiority of the tissues around the sutured defect, as well as the remaining large tensile loads in the suture area with a sudden increase in intra-abdominal pressure (cough, constipation, paresis.), the known method is ineffective.

The closest in terms of the achieved positive result (prototype) is the method of plasty of the defect of the aponeurosis of the anterior abdominal wall, which consists in excising all the cicatricial tissues of the aponeurosis and crossing the rectus abdominis muscles in the transverse direction (“Surgery”, M., 1984, 12, Polyansky B.A. , from.).

A positive result of the claimed invention is to increase the efficiency of plastic surgery of an anterior abdominal wall aponeurosis defect by reducing complications and recurrences in extensive surgical ventral hernias.

A positive result is achieved by the fact that to evenly distribute the load on the sutures on the abdominal wall outside the aponeurosis defect, corrugated sutures are applied on both sides of the defect, and the beginning of the sutures is equal to the size of the aponeurosis defect.

The method is illustrated with schematic drawings of the operation (see Fig.1 - 5).

The method is carried out as follows.

During the operation under general anesthesia in the area of ​​the hernial protrusion, a transverse elliptical incision of the skin and fatty tissue is performed, while excess tissue is removed. Then the hernial sac is opened, its revision is carried out, if necessary, enterolysis, resection of the omentum, the walls of the hernial sac are excised with a preliminary reduction of its contents into the abdominal cavity (Fig. 1).

After that, corrugated sutures are applied horizontally to the abdominal wall (figure 2) on both sides, and the beginning of the sutures outside the defect at a distance equal to the size of the aponeurosis defect. The grip width increases in the form of a triangle with its base facing the defect and equal to half of its size. The second row of corrugated seams closes the remaining half of the defect (Fig. 3).

Upon completion of suturing, the defect from a round or oval shape acquires a slit-like shape and is easily closed with separate interrupted sutures with the creation of a duplication without significant tissue tension (Fig. 4, 4a). The postoperative wound is sutured in layers leaving active drains brought out through separate counter-openings. The drains are removed after the termination of their function (figure 5).

Patient K., aged 60, was admitted in a planned manner. Clinical diagnosis: extensive postoperative ventral hernia in the mesogastric region, obesity of the III degree, sagging abdomen, hypertension of the II degree. She had a history of surgery two years ago for calculous cholecystitis. On examination: a hernial protrusion of 150x180 mm, when the hernia is reduced in the supine position, an aponeurosis defect of 80x100 mm is determined with thinning of the surrounding tissues.

When spirography - a violation of bronchial patency. With repeated spirography with dosed pneumocompression - worsening of bronchial patency compared to the original. An operation was performed according to the claimed method by plasty of the defect in the transverse direction with the imposition of unloading sutures, excision of the fatty apron and plastic of the defect itself duplicatively.

After the operation, antibiotic treatment was prescribed for 4-5 days. The sutures were removed on the 9th day. The postoperative period proceeded without complications. The control spirography revealed no violations of the ventilation function of the lungs. On the 10th day the patient was discharged in a satisfactory condition. Six months later, a follow-up examination was carried out - there was no recurrence.

The effectiveness of the proposed method is to improve the results of surgical treatment of ventral hernias in the meso- and hypogastric region by transverse plasty with the imposition of unloading corrugated sutures outside the area of ​​the abdominal wall defect. At the same time, the thinned, defective near-hernial area is strengthened, a sufficient reserve of tissues is created for duplication of the defect, and breaking loads on the sutures directly in the area of ​​the defect are reduced.

The claimed method is especially effective in aged patients with flabby abdominal wall, ptosis of varying degrees and concomitant pathology of the cardiopulmonary system.

A method for plasty of an anterior abdominal wall aponeurosis defect, including creating a duplication in the transverse direction, characterized in that a rounded defect is given a slit-like shape by applying two-row corrugated sutures to the abdominal wall on both sides of the defect in the horizontal direction, the first row of sutures starting at a distance equal to the size defect of the aponeurosis, increasing the width of the grip in the form of a triangle facing the base to the defect, then a second row of horizontal sutures is applied, after which the defect of the aponeurosis is sutured.

(21) Application registration number: 0/14

(22) Application date: 2000.12.05

(24) Starting date of the patent term: 2000.12.05

In the upper two-thirds of the rectus muscle, the anterior wall of the vagina is formed by the bundles of the aponeurosis of the external oblique muscle and the anterior plate of the aponeurosis of the internal oblique muscle; the back wall is the posterior plate of the aponeurosis of the internal oblique muscle and the aponeurosis of the transverse abdominal muscle. In the lower third of the rectus muscle, the aponeuroses of all three muscles pass to the anterior wall of the vagina.

Palmar aponeurosis: signs of the disease

In addition to the plantar aponeurosis, there are other varieties of this disease. For example, palmar is aponeurosis. What is it and how does this type of disease manifest itself? This disease occurs on the palmar part of the entire human hand. And if the patient has manifested such a disease as Dupuytren's contracture, then it makes sense to talk about the pathology of the aponeurosis of the palm.

With this disease, cicatricial contraction of this formation is observed. This is due to the fact that strands and nodes appear on it. As a result, contracture develops. This is when one or more fingers are bent all the time. Most of all, representatives of the stronger sex are affected by this disease. However, the reason has not yet been established. Some are used to thinking that it lies in hand injuries. But then every person of forty years old would be the owner of such a disease.

The development of the disease is slow. The affected area occupies two hands. There is only one way to cure the palmar aponeurosis - surgery. So with the manifestation of pain in the palms, it is necessary to contact specialists, and not self-medicate.

How to treat heel spurs?

Treatment is conservative in nature, and it will take a lot of time. If all procedures are done on time, then a stable remission will come.

During therapy, it is prohibited:

• long walk;
• stand on feet;
• carry heavy things;
• make movements in pain.

You will have to temporarily use special orthopedic products. Along with this, the doctor will prescribe an analgesic, a non-steroidal anti-inflammatory drug.

Many people experience discomfort in the foot after a long walk, playing sports, wearing uncomfortable shoes. However, not everyone thinks that this may be a signal of the beginning of the inflammatory process, which is caused by the problem of the heel spur.

Aponeurosis can disturb a person not only in the foot area, but also in the palms, abdominal muscles, and head. What is aponeurosis and how to treat it we will tell in this article.

Links

• Aponeurosis // Encyclopedic Dictionary of Brockhaus and Efron: In 86 volumes (82 volumes and 4 additional). - St. Petersburg. , 1890-1907.

Wikimedia Foundation. 2010 .

aponeurosis - aponeurosis ... Spelling dictionary-reference

APONEUROSIS - (from Greek apo from, and neuron nerve, muscle). Connecting membranes that attach muscles to bones. Dictionary of foreign words included in the Russian language. Chudinov A.N., 1910. APONEUROSIS is a tendon membrane that attaches muscles to bones. ... ... Dictionary of foreign words of the Russian language

Aponeurosis - connective tissue plate, with the help of which the muscles are fixed. In humans, the aponeurosis is also called the fascia of the sole and palm penetrated by tendon filaments ... Big Encyclopedic Dictionary

APONEUROSIS - (from apo. and Greek. neuron vein), a wide tendon plate of vertebrates, consisting of dense collagen and elastic fibers, through a swarm of some broad muscles attached to bones or other tissues of the body. A. naz. also fascia, ... ... Biological Encyclopedic Dictionary

aponeurosis - noun, number of synonyms: 5 disease (995) plate (47) sprain (14) ... Synonym dictionary

aponeurosis - a, m. aponévrose (amp) amp; LT; apo from, from neuron tendon. honey. A wide shiny connective tissue plate, through which the muscles are attached to the bones. Krysin 1998. Lex. SIS 1964: aponeuros / z ... Historical Dictionary of Gallicisms of the Russian Language

APONEUROSIS - (from the Greek aro from and neuron tendon, nerve), term, original. denoting the area of ​​the muscle located where muscle fibers pass into tendons. In a crust, time A. is usually called b. or m. wide connective tissue plate, ... ... Large medical encyclopedia

aponeurosis - a connective tissue plate with which muscles are fixed. In humans, the aponeurosis is also called the fascia of the sole and palm penetrated by tendon threads. * * * APONEUROSIS APONEUROSIS, a connective tissue plate, with the help of which ... ... Encyclopedic Dictionary

APONEUROSIS - (aponeurosis) a thin, but strong enough lobe of dense, formed fibrous connective tissue, replacing flat leaf-shaped tendons in muscles that are attached to bones for a considerable length (for example, external aponeurosis ... ... Explanatory Dictionary of Medicine

aponeurosis - (aponeurosis, PNA, BNA, JNA; Greek aponeurosis; ano neuron vein, tendon, nerve; syn. tendon stretch) 1) a wide connective tissue plate, consisting of dense collagen and elastic fibers, which are located larger ... ... Big Medical Dictionary

Causes of a hernia of the white line of the abdomen

For inflammation of the plantar aponeurosis, risk factors are.

Aponeurosis

Aponeuroses of the anterior abdominal wall (indicated in blue) and the linea alba

Aponeurosis(other Greek. ἀπο- - a prefix with the meaning of removal or separation, completion, reverse or return, negation, termination, transformation + νεῦρον "vein, tendon, nerve") - a wide tendon plate, formed from dense collagen and elastic fibers. Aponeuroses have a shiny, white-silver appearance. According to the histological structure, aponeuroses are similar to tendons, but are practically devoid of blood vessels and nerve endings. From a clinical point of view, the most significant are the aponeuroses of the anterior abdominal wall, the posterior lumbar region, and the palmar aponeuroses.

Aponeuroses of the anterior abdominal wall

The aponeuroses of the muscles of the anterior abdominal wall form the sheath of the rectus abdominis muscle. The vagina has an anterior and a posterior plate, while the posterior wall of the vagina at the level of the lower third of the rectus muscle is absent, and the rectus abdominis muscles are in contact with the transverse fascia with their back surface.

In the upper two-thirds of the rectus muscle, the anterior wall of the vagina is formed by the bundles of the aponeurosis of the external oblique muscle and the anterior plate of the aponeurosis of the internal oblique muscle; the back wall is the posterior plate of the aponeurosis of the internal oblique muscle and the aponeurosis of the transverse abdominal muscle. In the lower third of the rectus muscle, the aponeuroses of all three muscles pass to the anterior wall of the vagina.

Aponeuroses of the posterior lumbar region

The aponeuroses of the posterior lumbar region cover the longitudinal muscles of the lower back: the muscle that straightens the body (lat. m. erector spinae) and the multifidus muscle (lat. m. multifidus)

Palmar aponeuroses

Palmar aponeuroses cover the muscles of the palmar surface of the hands.

Skull aponeurosis

The supracranial aponeurosis, or tendon helmet (lat. galea aponeurotica) - aponeurosis located between the skin and the periosteum and covering the cranial vault; is an integral part of the occipital-frontal muscle, combining its occipital and frontal belly.

see also

Links

• // Encyclopedic Dictionary of Brockhaus and Efron: In 86 volumes (82 volumes and 4 additional). - St. Petersburg. , 1890-1907.

Wikimedia Foundation. 2010 .

Synonyms:

See what "Aponeurosis" is in other dictionaries:

Aponeurosis... Spelling Dictionary

- (from Greek apo from, and neuron nerve, muscle). Connecting membranes that attach muscles to bones. Dictionary of foreign words included in the Russian language. Chudinov A.N., 1910. APONEUROSIS is a membrane of tendons that attaches muscles to bones. ... ... Dictionary of foreign words of the Russian language

Connective tissue plate, with which the muscles are fixed. In humans, the aponeurosis is also called the fascia of the sole and palm penetrated by tendon filaments ... Big Encyclopedic Dictionary

- (from apo ... and Greek neuron lived), a wide tendon plate of vertebrates, consisting of dense collagen and elastic fibers, through which some wide muscles are attached to the bones or other tissues of the body. A. naz. also fascia, ... ... Biological encyclopedic dictionary encyclopedic Dictionary

APONEUROSIS- (aponeurosis) a thin, but strong enough petal of dense, formed fibrous connective tissue, replacing flat leaf-shaped tendons in muscles that are attached to bones over a considerable distance (for example, external aponeurosis ... ... Explanatory Dictionary of Medicine

- (aponeurosis, PNA, BNA, JNA; Greek aponeurosis; ano + neuron vein, tendon, nerve; syn. tendon stretch) 1) a wide connective tissue plate, consisting of dense collagen and elastic fibers, which are located larger ... ... Big Medical Dictionary