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The anterior abdominal wall has four muscles: The external oblique, the internal oblique, the transversalis, and the rectus muscles. The aponeuroses of the first three muscles form the rectus sheath, which encloses the rectus abdominis muscle.
The linea alba is a midline aponeurosis that runs from the xiphoid process to the pubic symphysis and separates the left and right rectus abdominis muscles. It is widest just above the umbilicus, facilitating entry into the peritoneal cavity.
For vascular trauma purposes, the retroperitoneum is conventionally divided into four anatomic areas:
Zone 1: Extends from the aortic hiatus to the sacral promontory. This zone is subdivided into the supramesocolic and inframesocolic areas. The supramesocolic area contains the suprarenal aorta and its major branches (celiac axis, superior mesenteric artery (SMA), and renal arteries), the upper inferior vena cava (IVC) with its major branches, and the superior mesenteric vein (SMV). The inframesocolic area contains the infrarenal aorta and IVC.
Zone 2: Includes the kidneys, paracolic gutters, renal vessels, and ureters.
Zone 3: Includes the pelvic retroperitoneum, containing the iliac vessels and ureters.
Zone 4: Includes the perihepatic area, with the hepatic artery, the portal vein, the retrohepatic IVC, and hepatic veins.
A large operating room (OR) situated near the emergency department, elevators, and ICU should be designated as the Trauma OR to facilitate the logistics of patient flow and minimize transport. The room should be securable for high profile patients.
A contingency plan for multiple simultaneous operations should be in place with the operating rooms in sufficient proximity to allow nursing and anesthesia cross-coverage and facilitate supervision of the surgical teams. Direct lines of communication between the OR, resuscitation area, ICU, other ORs, blood bank, and laboratory should be in place.
All rooms should have ample overhead lighting as well as access to portable headlamps.
Multiple monitors to display imaging, vital signs, and laboratory such as thromboelastometry, should be in place.
Hybrid operating and interventional radiology teams should be familiar with operating in the hybrid room.
A dedicated family waiting room should be identified, and all family should be directed to this area for the postoperative discussion.