Architecture of Peripheral Diaphragmatic Insertions
Abstract
We prepared 161 anatomical pieces to study the peripheral diaphragmatic insertions on the thoraco-abdominal wall. The anterior sterno-costal part and the posterior lumbo-costal regions of the diaphragm exhibit the highest anatomical variability, while the lateral costal part is more constant. The multiple mechanical forces which act upon the diaphragm and the forces exerted by the muscular parts of the diaphragm lead to various architectural dispositions in the diaphragm and especially at the level of it’s peripheral insertions. The anatomy of the peripheral diaphragmatic insertions can be better understood by comparison with architectural elements. The diaphragm inserts at the periphery on skeletal anatomical structures (procesus xifoideus, ribs, vertebrae) as well as on soft structures (posterior lamina of the theca of the musculus rectus abdominalis, endothoracal fascia of the intercostal spaces, fasciae of the quadratus lombae m. and the psoas m.) in a generally alternative manner. From an architectural point of view, the peripheral insertion of the diaphragm is a successive sequence of pillars and arcades (the pillars are the muscular fascicules and the arcades are arcade-shaped structures of connective tissue).
The validity of the classical anatomical descriptions of the peripheral diaphragmatic insertions remain unaltered, however, the reconsideration from an architectural point of view allows a better understanding of the disposition, variants and alterations under the action of various mechanical forces, under the dynamic influence of general anatomical changes like obesity and aging.