Лекции по топографической анатомии (английский язык)

И.В. БОЧКАРЕВА
О.А. КАЛМИНА

ЛЕКЦИИ

ПО ТОПОГРАФИЧЕСКОЙ 

АНАТОМИИ

(АНГЛИЙСКИЙ ЯЗЫК)

Лекции

Москва

ИНФРА-М

2019

УДК [611+811.111](075.8) 
ББК 54.54:81.2Англ.я73

Б86

Рекомендовано к изданию методической комиссией Медицинского института 
Пензенского государственного университета (протокол № 05 от 11.01.2018)

Р е ц е н з е н т ы :

Н.А. Плотникова
—
доктор медицинских наук, профессор, 

заведующий кафедрой нормальной и патологической анатомии с курсом 
судебной медицины Мордовского государственного университета имени 
Н.П. Огарева;

Е.А. Анисимова
—
доктор медицинских наук, профессор, 

профессор кафедры анатомии человека Саратовского государственного 
медицинского университета имени В.И. Разумовского

Бочкарева И.В.

Б86
Лекции по топографической анатомии (английский язык) : лекции / 

И.В. Бочкарева, О.А. Калмина. — М. : ИНФРА-М, 2019. — 102 с.

ISBN 978-5-16-107873-0 (online)

Издание 
посвящено 
общим 
вопросам 
топографической 
анатомии, 

топографической анатомии внутренних органов и областей тела человека. Особое 
внимание уделено клиническому значению особенностей топографии внутренних 
органов и сосудисто-нервных пучков.

Предназначено для обучающихся по специальности 31.05.01 «Лечебное дело».

Lectures are devoted to general issues of topographic anatomy, topographic 

anatomy of internal organs and areas of the human body. Particular attention is paid to the 
clinical significance of the features of topography of internal organs and neurovascular 
bundles.

The lectures are intended for students of specialty 31.05.01 “General Medicine” of 

medical university.

УДК [611+811.111](075.8) 

ББК 54.54:81.2Англ.я73

ISBN 978-5-16-107873-0 (online)
© Бочкарева И.В., Калмина О.А., 

2019

16+

Introduction to the topographic anatomy 
 
Topographic anatomy – the study of anatomy based on regions or 
divisions of the body and emphasizing the relations between various 
structures (muscles and nerves and arteries etc.) in that region. The main 
purpose of topographic anatomy is the determination of application tasks 
in practical medicine, in particular, in surgery. That’s why appointment 
“topographic anatomy” is often replaced with the term “surgeon anatomy” marking its importance for clinical surgery. Nevertheless, applying 
of topographic anatomy is very useful for doctors of different specialties. 
Therefore, learning of clinical anatomy is a basis of proper activity of 
every physician and nowadays it is considered that the surgeon anatomy 
is a branch of anatomy for preparing a surgeon – specialist.  
Applied anatomy is used to meet practical requirements of different branches of medicine, unlike systematic anatomy, that studies the 
body structure, its systems and organs. At the same time, some sections 
of topographic anatomy are quite useful in pictorial art, because they are 
describing reliefs of the body. It isn’t accidently that so called plastic 
anatomy is one of the oldest branches of anatomy that was well known 
by ancient sculptors and painters. Topographic anatomy has its own approaches and methods of contemplation of the human body. It considers 
organs and systems like a complex in a particular area that is needed by 
the physician or by the surgeon, instead of studying them separately. It is 
expected, that human anatomy is well known in consequence of the previous lectures. Topographic anatomy used to get a full notion about the 
spatial symmetry of all anatomical structures in every field of the human 
torso.  
Local knowledge of these relationships is very great interest to the 
practitioner. Violation of normal relations between individual entities 
leads to local disorders and painful symptoms. For example, damage to 
any even relatively small blood vessel can void the hematoma, a tumor 
in this area and change color skin, compression of nearby nerve trunk 
with the development of neurological symptoms, etc.  
Doctor who understands the topography of the corresponding area, 
in a survey of patient with high confidence may suggest about the damage of a vessel and which nerve trunks should be squeezed by hematomas, etc. Thus, knowledge of topographic anatomy allows you to 
properly analyze the observed symptoms and make an informed opinion, 
important for diagnosis.  

Another example: in the presence of the abscess, the surgeon can 
imagine possible ways of purulent leakage distribution and choose the 
optimum direction of incisions and place overlay contraperture for better 
drainage of purulent. He can make those decisions based on knowledge 
about the location of fascial slips, about direction of interfascial fissures 
and other. Finally, only a deep knowledge of topographic anatomy of 
this specific area can provide the surgeon with a thought-out plan surgery. This will help avoid damage to major blood vessels and nerves and 
to comply with all the necessary surgical operations. 
To examine the topography of the area is advisable to use a method called “window preparation”. The method involves cutting out a rectangular flap with a scalpel in a relatively small area of a human body, 
where is studied layer by layer all anatomical structures: vessels and 
nerves, muscles and the vascular-nervous bundles that are underlying the 
muscles. 
A set of topographic and anatomical data about each object can be 
reduced to the description of the three primary characteristics:  
1. 
Position determination of anatomical object in relation to the human 
body as a unit (holotopy); 
2. 
Conclusion of the location of the target relative to bony landmarks 
as the most permanent and relatively accessible by visual observation and by palpation or x-ray survey (skeletopy); 
3. 
The position of an organ relative to other organs (syntopy). 
A collection of information about holotopy, skeletopy and syntopy 
of each entity in the relevant area of the human body and is the main 
content of topographic anatomy. 
To determine holotopy of different organs usually uses concepts 
that are well known in anatomy: relation to the sagittal and front plane 
and telling to the horizontal levels. In different cases three-dimensional 
reference system is applied for more accurate specifications of holotopy 
that is fixed relative to the selected reference point.  
Determination of skeletotopy is made by projecting borders of the 
organ or its most important parts on bony landmarks. For a more accurate definition of skeletopy are applied radiography and fluoroscopy 
with using of radiodense drug when it is required.  
For syntopy research of physical structures and their parts topographic anatomy has special methods. For this purpose, body cuts in different planes, injections of various dyes, x-ray examinations in various 
projections, ultrasonic research can be used. The particular interest represents the most modern methods of computer tomography and nuclear 
resonance, allowing to obtain images of internal organs in any angles 

and planes with the ability of mathematical processing of images. However, such a clinical approach to the study of topographic anatomy puts 
forward a number of new issues. The problem of healthy and diseased 
human individuality should be put in the first place. It is well known that 
didn’t exist two absolutely similar people, even by their appearance 
(growth, weight, eye color and hair and etc.). To this should be added 
the age, sex and race and others. These differences are also noticed on 
deep functional, morphological, biochemical and molecular levels. In 
patient’s body can change the constant ratio described in anatomical 
manuals as a result of the pathological disorders. The doctor must deal 
with topographic anatomy not only of a healthy body, but also of a sick 
body. That’s why the definition of clinical anatomy becomes more complicated.  
The main problem in human studies is the ratio of part and whole, 
form and function. That problem attracted attention of many clinicians 
and anatomists. In general terms, it has been reflected in anthropology, 
like a teaching about the constitution. 
The concept of the constitution includes a lot of structural and 
functional features that are caused by genetic factors and long and intense influence of the surroundings. The constitution can be seen as an 
integral feature of human individuality, as a kind of “biological passport”. Application of the concept of the constitution is found in the diagnosis, treatment, evaluation of the physical status of the individual, and 
so on. Most scholars have emphasized the need to identify the correlations between common anthropometric characteristics (for example: between body shape, weight, human growth and other). It can be also between estimated forms of the topographic areas, on the one hand, and 
anatomical characteristics that compose the morphological basis of the 
function of internal organs and organism in general, on the other hand. 
 
 
The study about extreme forms of individual 
variability of the organs and systems  
of the human body 

 
The notion of the extreme variability of the organs and systems of 
the human body received its explanation in the works of academician 
Shevkunenko.  
His writings and works of his students formed the basis for the 
creation of a new direction in applied anatomy. This direction implies 

the study of the definition of the scientific approach to the identification 
of patterns of individual variability, instead of examining individual cases. Numerous studies have provided a large number of anatomical facts, 
that confirmed the existence of individual differences in the structure 
and topography of different bodies. This enabled Shevkunenko to formulate the first postulate of his theory: every organ and system in the human physical structure are revealed by individual variability.  
It has been proven that anatomical variants are not accidental, the 
basis of their appearance is the law of the development of the organism. 
The diversity of shapes and positions of organs and systems can be presented like variational series, based on the most important morphological 
characteristics, whose changes can be traced in their processes of phylogenesis and ontogenesis. The most distinct signs will be located at the 
end of that series. The term “extreme variability” became applied to denote these signs.  
Thus, the application of the principles of variation statistics to the 
study of individual variability is the second provision of the teachings of 
Shevkunenko. And as well the use of variational series for analysis of 
variability and frequency of occurrence of individual options. 
The main purpose of identifying extreme variability is to give to a 
practicing doctor a concept of borders, in which can vary, for example, 
the location of the body or its structure. However, Shevkunenko emphasized that for the building of some variational series and for the correct 
interpretation of consistent patterns it is important to take into account 
“the direction of development”, choosing from many morphological 
characteristics, those that are determined by processes of phylogenesis 
and ontogenesis. And of course, it should be taken into account that the 
development of organs, systems and the whole body is influenced by biological and social environmental factors. 
Thus, the third thesis of doctrine of Shevkunenko can be formulated as follows: individual anatomical differences aren’t an amount of coincidences. They are limited by laws of ontogenesis and phylogenesis 
and are formed in the process of complex interactions between a growing organism and environmental elements.  
The result of the works of Shevkunenko and his school has expanded the notion of anatomical norm. All options within the variation 
range, and those that reflect the different stages of development of an 
organ or system, should be considered as normal. Therefore, the norm is 
a varies complex of morphological features and the range of the observed anatomical differences, the boundaries of which are extreme variability. It is important to emphasize that the function of organs and sys

tems is maintained and it provides vital functions of the body within this 
range of individual variability (while maintaining adequate correlation 
with environmental factors). This comment is very important because 
there are indications that in the event of extreme influences resistance of 
anatomic and functional structures and complexes may be different, depending on the anatomical features organ or system. In particular, this 
can be illustrated by the various compensatory possibilities of regional 
vascular beds with thrombosis and embolism, depending on the degree 
of expression of anastomoses and collaterals.  
Along with the concept of norm, the doctrine of Shevkunenko 
about extreme forms of individual variability can also clarify the meaning of the term “anomaly” and “malformation”. Anomaly, as anatomical 
fact, as a result of an abnormal process of development by maintaining 
the functions. A classic example of an anomaly – “situs viscerum inversus”.  
Developmental disabilities are congenital disorders of anatomical 
structure (location) of organs, that have larger or smaller abnormalities 
(for example: clefts of the ductus arteriosus between aorta and pulmonary artery, clefts of interventricular septum and etc.). 
 
 
Main directions of the development  
of the theory of variability 
 
Modern medicine needs the further development and deepening of 
doctrine of Shevkunenko. At the present stage this doctrine is evolving 
in several directions. 
The first and most traditional direction: identification of individual 
variability in order to develop rational surgical approaches and operational techniques. It currently attracts special attention due to the need of 
clinical and anatomic study of new methods of reconstructive surgery of 
blood vessels and the introduction of microsurgical methods. 
The second direction, that is usually called clinical – morphological, studies the morphological basis of clinical symptoms, pathogenesis 
and peculiarities of the various diseases. The purpose of this direction is 
studying of the variability of organs and systems to ascertain the causes 
of the different manifestations of the same disease in different cases, to 
analyze ways of thrombosis and thrombophlebitis, to study irradiation of 
pain and many others. 

However, the differences that are observed in the structure of the 
organs and systems of the human body, are set for direct use in the clinic 
and for identification of broad patterns of physiological and general biological nature. 
 In this connection, the third area could be called medicalbiological. It received a special development in 70–80 years in the works 
of many pupils and followers of Shevkunenko. In these works, has been 
convincingly demonstrated the role of specific organs and whole topographic-anatomical complexes in the regulation of the life of the organism, the maintenance of homeostasis and adaptation to extreme conditions. 
The fourth direction in studying the features of a structure of the 
human body, called anatomical – surgical, is of particular interest. This 
term isn’t quite right, because it is associated with surgical anatomy. In 
fact, it is a study of the topography and the areas, that are affected by 
pathologic processes and it is only a change of topography. This direction is very important for operating surgeons, because at the time of operation they had to deal with the destruction caused by a pathological 
process (tumor as an example). Only the knowledge of previous normal 
relations helps the surgeon to navigate with removing the pathological 
focus. Unfortunately, it is still the least developed direction. 
Finally, consider the fifth pillar: studies on age variability. It’s well 
known that development of an organism begins from the fertilization and 
continues in the prenatal period and in postnatal until the death. The rate 
of development of the various tissues, organs and systems and the depth 
of observed changes occurs at different speeds and intensity in the different periods of development of the human body. This continuous process of development makes important differences in the structure and topography of bodies at different stages of human life. Accordingly, there 
are significant functional changes that lead to the different reactivity and 
adaptability and resistance to the effects of external factors. The approach of physicians and surgeons, has long been known, in particular, 
to the treatment of patients of different age, leading to the division into 
independent sectors children's surgery and gerontology. 
Age-related changes in the anatomical ratios can be illustrated by 
the proportions of the human body. For example, the vertical size of the 
baby's head is about 1/4 of the length of the body, but in an adult, this 
ratio does not exceed 1/8. The differences in the topography of internal 
organs are clearly expressed, so have to take this into account when performing operations, especially in newborns. For example, the lower edge 
of the liver in the newborn heavily favored from the costal arch, some

times almost reaching to the level of the iliac crest. The ratio of the liver 
with neighboring bodies in adults is different: the liver significantly 
drives back down the stomach and spleen, the rear surface of the liver to 
a significant section is adjacent to the right adrenal gland, etc.  
Specific changes to the topography of the internal organs can be 
observed in old age: it is known that elderly people often have an omission of viscera, elongation of the ligaments, changing the shape of the 
bladder, etc. These examples relate only to two age groups- infants and 
the elderly people. However, changes to the topography of the body occur gradually throughout whole life. Therefore, we can speak about identification of features of the topography for every age. However, for accuracy of scientific analysis, we must take into account that there are socalled critical periods in the process of ontogenesis (change of conditions of supply, the intensity of the exchange, of the lifestyle).  
So, first, to examine age variability material must be properly distributed by age group, excluding the aggregation errors the received data 
and comparing them with the results of other researchers. Secondly, we 
should understand that within each age group are some individual variability patterns. Therefore, the main task of studying age anatomic variability becomes identifying the range of individual differences within 
each age group, followed by analysis of changes.  
Using the guidelines of exercise of Shevkunenko, we must understand that in every age group can identify the specific individual differences, because of the processes of growth and development occur with 
varying intensity. So, the study of individual variability should be not 
exactly on this given population, but separately, in each age group. Only 
in this way can be obtained enough evidence and regularities typical for 
a certain period of human development. 
Ending with the presentation of the information on the content, objectives, methods of research and development in clinical anatomy, the 
present stage, it is necessary to emphasize its the inextricable link with 
clinical surgery and surgical technique. 
 
 
 

Topographic regularities of pathways  
of purulent process 
 
The purulent processes develop and spread in the subcutaneous 
and intermuscular cellular tissue, along the fascial sheath of neurovascular fascicles, along the fascial sheaths and interfascial fissures, through 
intermuscular spaces, etc. 
All ways of spreading of the pus from the primary focus of inflammation in neighboring areas can be divided into two groups: primary and secondary. 
The primary pathways can be characterized as ways through which 
pus spreads and doesn’t destroy anatomical structures and elements, during the “meltdown” of the cellular tissue in the interfascial and intermuscular spaces. The connective tissue and the fatty tissue are the “locus 
minoris resistentiae”, along which pus spreads. 
The spread of the pus over the secondary pathways is accompanied 
by the destruction of anatomical structures and elements and the rupture 
of closed fascial sheaths or intermuscular spaces into neighboring areas. 
 
 
The primary pathways of purulent process 

 
The main pathways of purulent process are determined by the direction of fasciae, along which pus spreads. 
Fasciae differs from each other in the structure and functional features, that are a reflection of the development.  
In accordance with the teachings of Shevkunenko, depending on 
the source of origin, they are divided into several groups: muscular, connective, coelomic and fasciae that surround neurovascular fascicles. 
The mechanism of development of connective and, also, of the 
muscular origin, is different. The connective tissue fasciae can develop 
due to compaction of connective tissue membranes around moving muscles (groups and separated). Fasciae that surround neurovascular fascicles are formed by the compacted loose cellular tissue, that forms the 
fascial sheaths of major neurovascular fascicles. 
Muscular fasciae are formed by: 
1) The transformation of the terminal parts of the muscles, that are 
constantly in tension, into dense connective – tissue laminae (palmar aponeurosis, plantar aponeurosis, the aponeurosis of the abdominal external oblique muscle).