1. Examine the round ligament of uterus or spermatic cord and inguinal canal.
Review the area of the superficial inguinal ring. Reflect the external abdominal oblique aponeurosis. Note the internal abdominal oblique muscle. Recall that the muscle jumps from the middle of the inguinal ligament to the pubic crest to form the falx inguinalis. Recall also that the fibers of the internal abdominal oblique invest the spermatic cord as the cremasteric layer. Reflect the cord laterally to expose the fascia lying deep to the falx inguinalis. This fascia is called the weak fascia and is a portion of the transversalis fascia that lines the abdominal wall. At the lateral margin of the falx inguinalis, look for the deep inguinal ring that is an extension of the transversalis fascia around the spermatic cord. Medial to the deep ring, look for the inferior epigastric vessels. The weak fascia of the inguinal triangle is the site of a direct inguinal hernia. Next, retract the falx inguinalis to reveal the lacunar ligament. The lacunar ligament sweeps from the medial corner of the inguinal ligament back toward the pectineal line. The lacunar ligament continues posteriorly along the pectineal line as the pectineal ligament. Now identify the ilioinguinal nerve on the spermatic cord. It lies on the cremasteric layer. Reflect the cremasteric layer from the spermatic cord with careful blunt dissection. Look for muscle bands within this layer. Inside the cremasteric layer, look for a small nerve to the muscle, the genital branch of the genitofemoral nerve. It may be difficult to find. Deep to the cremasteric layer, there is another layer of fascia called the internal spermatic fascia. This is an extension of the transversalis fascia. Carefully dissect this layer away from the cord contents. Expose the round ligament in the female by cutting through the external abdominal oblique aponeurosis and reflecting it. Lying on the internal abdominal oblique muscle is the ilioinguinal nerve which pentrates the internal abdominal oblique and lies on the round ligament. An extension of the internal abdominal oblique muscle covers the round ligament - the cremasteric layer - which may or may not have muscle fibers within it. You may reflect this layer to expose the round ligament. The round ligament is a band of connective tissue with surrounding fat and small vessels. Reflect the round ligament laterally to expose the falx inguinalis. The falx inguinalis arches over an area of weak fascia made of transversalis fascia that spans between the falx inguinalis and the inguinal ligament. At the lateral margin of the falx, note the inferior epigastric artery and that the round ligament passes just lateral to it.
If you have difficulty receiving this movie, try the smaller version.