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Clinics in Colon and Rectal Surgery May 2022Despite advancements in understanding and technique, there remain significant challenges in the management of a complex perineal wound following pelvic surgery.... (Review)
Review
Despite advancements in understanding and technique, there remain significant challenges in the management of a complex perineal wound following pelvic surgery. Complications including wound sepsis, fistulation, persistent sinus, and herniation produce additional morbidity and health care costs. This article details the methods of optimizing patient and operative factors to mitigate this risk, alongside strategies to deal with sequelae of wound failure.
PubMed: 35966381
DOI: 10.1055/s-0042-1742414 -
Lakartidningen Nov 2018
Topics: Female; Humans; Physical Therapy Modalities; Pregnancy; Pregnancy Complications; Prune Belly Syndrome; Rectus Abdominis; Tomography, X-Ray Computed
PubMed: 30457664
DOI: No ID Found -
The Ultrasound Journal Jun 2019Rectus sheath hematoma (RSH) is an uncommon entity associated with predisposing factors such as anticoagulation. It may mimic more frequent abdominal conditions and its...
BACKGROUND
Rectus sheath hematoma (RSH) is an uncommon entity associated with predisposing factors such as anticoagulation. It may mimic more frequent abdominal conditions and its accurate diagnosis is important to focus on the correct treatments and improve morbidity and mortality.
CASE PRESENTATION
An elderly patient with shock, abdominal pain, palpable abdominal mass, and anemia was suspected of having a large RSH by point-of-care ultrasound (POCUS), which was then confirmed by computed tomography. Surgery was performed, markedly improving his clinical status.
CONCLUSIONS
POCUS has a good sensitivity for the diagnosis of RSH and it is also an excellent tool for patient follow-up.
PubMed: 31359170
DOI: 10.1186/s13089-019-0129-4 -
Evidence-based Complementary and... 2022To evaluate the changes of rectus abdominis thickness and inter-rectus distance before and after delivery with high-frequency ultrasound.
OBJECTIVE
To evaluate the changes of rectus abdominis thickness and inter-rectus distance before and after delivery with high-frequency ultrasound.
METHODS
A total of 148 pregnant women at 12 weeks of gestation who underwent prenatal examination in our hospital from January 2019 to March 2020 were selected, and 140 of them cooperated with rectus abdominis examination. According to the results of rectus abdominis examination 42 days after delivery, 97 patients were divided into the DRA group with rectus abdominis isolated and 43 patients were divided into the normal group with rectus abdominis not isolated. At 12 weeks, 24 weeks, and 37 weeks of pregnancy, 3 days and 42 days after delivery, the thickness and spacing of the left and right rectus abdominis muscle were measured by high-frequency ultrasound along the white linea at three positions: 5 cm above the navel, 3 cm below the umbilical edge, and 3 cm below the navel.
RESULTS
The thickness of rectus abdominis at 5 cm above the navel, 3 cm below the navel, and at the navel margin of the abdominal white line in the pregnant women of the two groups was gradually decreased with the increase of the pregnancy cycle and gradually recovered after delivery. At 42 days after delivery, the thickness of rectus abdominis in the DRA group was significantly lower than that in the normal group, which was 5 cm above the umbilicus, 3 cm below the umbilicus, and the umbilical margin of the abdominal white line ( < 0.05). The space between rectus abdominis 5 cm above the navel, 3 cm below the navel, and the navel margin of the abdominal white line in the pregnant women of the two groups was gradually increased with the increase of the pregnancy cycle and gradually recovered after delivery. At 37 weeks of pregnancy, 3 days after delivery, and 42 days after delivery, the space of rectus abdominis along the umbilicus 5 cm above, 3 cm below the umbilicus, and the umbilicus border of the abdominal white line in the DRA group was significantly larger than that of the normal group ( < 0.05).
CONCLUSION
Ultrasound can accurately measure the inter-rectus distance and rectus thickness, accurately evaluate the degree of DRA, and realize the one-stop evaluation from prenatal diagnosis and prediction to postpartum rehabilitation monitoring, so as to intervene during pregnancy and reduce the risk of postpartum DRA.
PubMed: 36062170
DOI: 10.1155/2022/9751136 -
Plastic and Reconstructive Surgery.... Jan 2022The deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction has been popularized over the transverse rectus abdominis myocutaneous (TRAM) flap,...
UNLABELLED
The deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction has been popularized over the transverse rectus abdominis myocutaneous (TRAM) flap, as it spares rectus abdominis muscle and has low donor site morbidity. This progression to muscle preservation, however, has been associated with an increased difficulty in vascular dissection, perfusion-related complications, and lengthier surgical times. We pilot a technique that may achieve the benefits of the TRAM flap in terms of ease of dissection and vascularity, with the benefits of the DIEP flap in terms of maintaining rectus abdominis continuity.
METHODS
A cohort of six consecutive patients underwent a free TRAM flap for reconstructive surgery. All patients underwent a segmental, periumbilical harvest of rectus abdominis muscle as part of flap design, and the segmental defect was reconstructed with an innervated rectus abdominis perforator turndown (RAPT) flap harvested supraumbilically. Postoperative assessment of rectus continuity was performed clinically, with muscle electromyography and ultrasound.
RESULTS
In all six cases, there was successful TRAM flap transfer, with no flap-related complications. Rectus abdominis muscle reconstruction with the RAPT flap was achieved, with continuity and function of the rectus muscle confirmed.
CONCLUSIONS
We describe the innervated RAPT flap for reconstitution of rectus continuity after TRAM flap harvest. This technique may achieve the benefits of the TRAM flap in terms of ease of dissection and flap vascularity, and the benefits of the DIEP flap in terms of maintaining rectus abdominis continuity.
PubMed: 35186617
DOI: 10.1097/GOX.0000000000004037 -
Scientific Reports Mar 2023Hernia occurs when the peritoneum and/or internal organs penetrate through a defect in the abdominal wall. Implanting mesh fabrics is a common way to reinforce the...
Hernia occurs when the peritoneum and/or internal organs penetrate through a defect in the abdominal wall. Implanting mesh fabrics is a common way to reinforce the repair of hernia-damaged tissues, despite the risks of infection and failure associated with them. However, there is neither consensus on the optimum mesh placement within the abdominal muscles complex nor on the minimum size of hernia defect that requires surgical correction. Here we show that the optimum position of the mesh depends on the hernia location; placing the mesh on the transversus abdominis muscles reduces the equivalent stresses in the damaged zone and represents the optimum reinforcement solution for incisional hernia. However, retrorectus reinforcement of the linea alba is more effective than preperitoneal, anterectus, and onlay implantations in the case of paraumbilical hernia. Using the principles of fracture mechanics, we found that the critical size of a hernia damage zone becomes severe at 4.1 cm in the rectus abdominis and at larger sizes (5.2-8.2 cm) in other anterior abdominal muscles. Furthermore, we found that the hernia defect size must reach 7.8 mm in the rectus abdominis before it influences the failure stress. In other anterior abdominal muscles, hernia starts to influence the failure stress at sizes ranging from 1.5 to 3.4 mm. Our results provide objective criteria to decide when a hernia damage zone becomes severe and requires repair. They demonstrate where mesh should be implanted for a mechanically stable reinforcement, depending on the type of hernia. We anticipate our contribution to be a starting point for sophisticated models of damage and fracture biomechanics. For example, the apparent fracture toughness is an important physical property that should be determined for patients living with different obesity levels. Furthermore, relevant mechanical properties of abdominal muscles at various ages and health conditions would be significant to generate patient specific results.
Topics: Humans; Abdominal Wall; Herniorrhaphy; Surgical Mesh; Hernia, Ventral; Incisional Hernia; Abdominal Muscles
PubMed: 36973304
DOI: 10.1038/s41598-023-31674-w -
Cureus Aug 2018The rectus abdominis muscles are interrupted by tendinous inscriptions, which typically appear as fibrous bands crossing the muscle. The current literature on tendinous... (Review)
Review
The rectus abdominis muscles are interrupted by tendinous inscriptions, which typically appear as fibrous bands crossing the muscle. The current literature on tendinous inscriptions is scarce; hence, this review will provide a detailed overview of their anatomical description, including their variation, embryology, comparative anatomy, and clinical application. Understanding the anatomy and function of the tendinous inscription assists in providing clinical relevance and in guiding reconstructive surgeons in their surgical planning and design.
PubMed: 30338176
DOI: 10.7759/cureus.3100 -
World Journal of Psychiatry May 2024Rectus abdominis separation (DRA) affects pelvic stability and body image. No studies have explored the effects of manual massage on early postpartum DRA and postpartum...
BACKGROUND
Rectus abdominis separation (DRA) affects pelvic stability and body image. No studies have explored the effects of manual massage on early postpartum DRA and postpartum depression.
AIM
To analyze the curative effect of massage on early postpartum DRA and its impact on postpartum depression and thus its ability promote the overall psychosomatic rehabilitation of postpartum women.
METHODS
Data were retrospectively collected on 70 primiparous women with postpartum DRA who underwent rehabilitation at the Postpartum Rehabilitation Center of Huzhou Maternal and Child Health Hospital from October 2022 to September 2023. The patients were divided into the Group S (35 cases, biomimetic electrical stimulation treatment) and Group L (35 cases, biomimetic electrical stimulation combined with manual massage treatment). Baseline data, the edinburgh postpartum depression scale (EPDS) score, and the visual analog scale (VAS) scores for rectus abdominis distance, waist circumference, and lower back pain before and after treatment were compared.
RESULTS
No significant differences were found in the baseline data, rectus abdominis distance, waist circumference, and VAS and EPDS scores between the two groups before treatment ( > 0.05). After treatment, the distance between rectus abdominis and waist circumference in Group L were significantly smaller than those in Group S ( < 0.05). Furthermore, lower back pain (VAS score) and the EPDS score in Group L were significantly lower than those in Group S ( < 0.05).
CONCLUSION
Manual massage can significantly reduce early postpartum DRA, waist circumference, and back pain and improve the patient's mental state and postpartum depression.
PubMed: 38808091
DOI: 10.5498/wjp.v14.i5.678 -
Gland Surgery Jun 2015Abdominally based free flaps have become the mainstay for women that desire to use their own tissue as a means of breast reconstruction after mastectomy. As the... (Review)
Review
Abdominally based free flaps have become the mainstay for women that desire to use their own tissue as a means of breast reconstruction after mastectomy. As the techniques have evolved, significant effort has been invested in finding the best means of minimizing morbidity to the abdominal donor site while ensuring a viable reconstructed breast that is aesthetically pleasing. This manuscript reviews and compares the muscle sparing free transverse rectus abdominis myocutaneous (MsfTRAM), the deep inferior epigastric artery perforator (DIEP), and the superficial inferior epigastric artery (SIEA) flaps, regarding flap success rate, operative times, abdominal donor site morbidity and residual functionality, hospital lengths of stay and associated costs, impact of co-morbid conditions, and resilience after adjuvant radiation treatment.
PubMed: 26161306
DOI: 10.3978/j.issn.2227-684X.2015.03.08