Open the anterior wall of the rectus sheath (Figure 35.4). First, make a vertical incision parallel and 2-3 cm lateral to the linea alba from the pubic symphysis to the xiphoid process . From each end of the vertical incision, make a transverse incision towards linea semilunaris. As the anterior portion of the rectus sheath is being reflected laterally , sever the connections between the tendinous intersections of the rectus abdominis muscle and the anterior layer of the rectus sheath. Three tendinous intersections divide the rectus abdominis muscle into segments. The rectus abdominis muscle is innervated by the
thoracoabdominal nerves that pass through the muscle and pierce the anterior layer of the rectus sheath.
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