ABSTRACT
The superior leaflet of the rectus sheath is reflected off the rectus muscle for a distance of 3 to 4 cm. To achieve this, two Allis clamps are applied to the superior leaflet of the rectus sheath on either side of the midline, and gentle traction is exerted. The rectus sheath is connected to the rectus muscle only by loose areolar tissue laterally and fibrous tissue along the midline. This is separated easily by a combination of blunt dissection and electrocautery (Figure 11.1C). A few small branches of the inferior epigastric artery pierce the rectus muscle and supply the rectus sheath. These should be identified and cauterized, because they may be avulsed easily and retract into the rectus muscle, possibly leading to a rectus hematoma.
