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Medicine Sep 2023The impact of deep inferior epigastric artery perforator (DIEP) flap on abdominal wall integrity has been the topic of an ongoing debate with previous studies having...
Ultrasonographic assessment of rectus abdominis muscle adaptation after deep inferior epigastric artery perforator (DIEP) flap surgery: Single institution retrospective study.
The impact of deep inferior epigastric artery perforator (DIEP) flap on abdominal wall integrity has been the topic of an ongoing debate with previous studies having reported conflicting results using various imaging modalities. Ultrasonography is a noninvasive, cost-effective, and readily available method for evaluating the changes to the rectus muscle after DIEP flap surgery. In the present study, we aimed to compare rectus abdominis muscle thickness between the operated and non-operated sides using ultrasound imaging. The muscle thickness was measured at the cross point of the midclavicular line and the level of the umbilicus and anterior superior iliac spine using real-time B-mode ultrasonography. The muscle anteroposterior diameters of the pedicle-dissected side and the control side were compared using paired t test. In total 31 patients with a mean follow-up of 70.18 weeks were included. The mean diameters at the level of the umbilicus of the operated and non-operated sides were 8.16 ± 1.83 and 8.14 ± 1.43 mm, respectively (P = .94). The mean thicknesses at the anterior superior iliac spine level were 7.74 ± 1.85 on the flap harvested side and 8.04 ± 1.84 mm on the control side (P = .35). There was no statistically significant difference between the 2 groups. Ultrasonography can be a reliable, inexpensive, and easily usable modality for evaluating donor site complication following DIEP flap. DIEP flap seems to have minimal impact on the abdominal donor site, and it may be safe and versatile to reconstruct the breast after mastectomy.
Topics: Humans; Female; Rectus Abdominis; Retrospective Studies; Breast Neoplasms; Epigastric Arteries; Mastectomy; Crassulaceae; Oculomotor Muscles; Mammaplasty
PubMed: 37657015
DOI: 10.1097/MD.0000000000034721 -
3D Printing in Medicine Sep 2023Deep Inferior Epigastric Perforator Flap (DIEP) surgical procedures have benefited in recent years from the introduction of 3D printed models, yet new technologies are...
BACKGROUND
Deep Inferior Epigastric Perforator Flap (DIEP) surgical procedures have benefited in recent years from the introduction of 3D printed models, yet new technologies are expanding design opportunities which promise to improve patient specific care. Numerous studies, utilizing 3D printed models for DIEP, have shown a reduction of surgical time and complications when used in addition to the review of standard CT imaging. A DIEP free flap procedure requires locating the inferior epigastric perforator vessels traversing and perforating the rectus abdominis muscle, perfusing the abdominal skin and fatty tissue. The goal of dissecting the inferior epigastric perforator vessels is complicated by the opacity of the fatty tissue and muscle. Previous attempts to 3D print patient specific models for DIEP free flap cases from CT imaging has shown a wide range of designs which only show variations of perforator arteries, fatty tissue, and the abdominis rectus muscle.
METHODS
To remedy this limitation, we have leveraged a voxel-based modeling environment to composite complex modeling elements and incorporate a ruled grid upon the muscle providing effortless 'booleaning' and measured guidance.
RESULTS
A limitation of digital surface-based modeling tools has led to existing models lacking the ability to composite critical anatomical features, such as differentiation of vessels through different tissues, coherently into one model, providing information more akin to the surgical challenge.
CONCLUSION
With new technology, highly detailed multi-material 3D printed models are allowing more of the information from medical imaging to be expressed in 3D printed models. This additional data, coupled with advanced digital modeling tools harnessing both voxel- and mesh-based modeling environments, is allowing for an expanded library of modeling techniques which create a wealth of concepts surgeons can use to assemble a presurgical planning model tailored to their setting, equipment, and needs.
TRIAL REGISTRATION
COMIRB 21-3135, ClinicalTrials.gov ID: NCT05144620.
PubMed: 37700101
DOI: 10.1186/s41205-023-00181-z -
Physical Therapy May 2024The long-term effects of the unilateral muscle-sparing pedicled transverse rectus abdominis myocutaneous (TRAMmsp) flap procedure on trunk muscle performances and core...
OBJECTIVE
The long-term effects of the unilateral muscle-sparing pedicled transverse rectus abdominis myocutaneous (TRAMmsp) flap procedure on trunk muscle performances and core stability were investigated in women with breast cancer.
METHODS
Forty women (mean age = 42.6 years) who had received breast reconstruction with the unilateral TRAMmsp flap procedure no less than 6 months earlier (mean = 10.3 [standard deviation, SD = 4.9] months) (TRAM group) participated, and 30 women who were healthy and matched for age (mean age = 41.2 years) served as controls (control group). Their abdominal and back muscle strength was assessed using the curl-up and prone extension tests, respectively, and their static abdominal muscle endurance and back extensor endurance were assessed using the sit-up endurance test in the crook-lying position and the Biering-Sørensen test, respectively. Core stability strength was assessed using a 4-level limb-lowering test (abdominal muscle test), and core stability endurance was assessed while lying supine with both flexed legs 1 inch off the mat while keeping the pelvis in a neutral position with a pressure biofeedback unit.
RESULTS
Compared with the control group, trunk muscles of the TRAM group were weaker, showing less endurance, as were their core stability strength and endurance. Static trunk muscle endurances and trunk flexion strength were associated with core stability in both groups.
CONCLUSIONS
Women exhibit trunk flexor and extensor weakness along with poor endurance and impaired core stability even after an average of 10 months from receiving the TRAMmsp flap procedure. Immobilization after surgery, with possible systemic inflammatory effects from surgery and chemotherapy, might have further contributed to the generalized weakness subsequent to the partial harvesting of the rectus abdominis.
IMPACT
Women after breast reconstruction with the TRAMmsp flap procedure show long-lasting deficits of strength and endurance in abdominal muscles, back extensors, and core stability. Proactive measures including early detection and evaluation of impairments as well as timely intervention targeting these clients are important to minimize the dysfunction and support their return to community participation.
Topics: Humans; Female; Mammaplasty; Muscle Strength; Rectus Abdominis; Adult; Myocutaneous Flap; Breast Neoplasms; Middle Aged; Case-Control Studies
PubMed: 38394671
DOI: 10.1093/ptj/pzae026 -
Journal of Medical Ultrasonics (2001) Oct 2023We examined the association of activities of daily living (ADL), mobility and balance ability, and symptoms of Parkinson's disease (PD) with the masses and amounts of...
Association of activities of daily living, mobility and balance ability, and symptoms of Parkinson's disease with the masses and amounts of intramuscular non-contractile tissue of the trunk and lower extremity muscles in patients with Parkinson's disease.
PURPOSE
We examined the association of activities of daily living (ADL), mobility and balance ability, and symptoms of Parkinson's disease (PD) with the masses and amounts of intramuscular non-contractile tissue of the trunk and lower extremity muscles in patients with PD.
METHODS
The subjects were 11 community-dwelling patients with PD. ADL were assessed using the Functional Independence Measure. Mobility capacity was assessed based on measurement of maximal walking speed and timed up-and-go time, while balance ability was evaluated based on measurement of one-legged stance time. The symptoms of PD were assessed based on measurement of the Hoehn and Yahr stage and Unified Parkinson's Disease Rating Scale. Muscle thickness (MT) and echo intensity (EI) of the trunk and lower extremity muscles were also measured using an ultrasound imaging device.
RESULTS
Partial correlation analysis revealed an association between reduced ADL and increased EI of the lumbar erector spinae muscle; reduced mobility capacity and increased EI of the rectus abdominis and gluteus minimus muscles; and reduced balance ability and decreased MT of the lumbar erector spinae muscle and increased EI of the lumbar erector spinae, semitendinosus, and tibialis posterior muscles. Partial correlation analysis also showed an association between symptoms of severe PD and decreased MT of the tibialis anterior muscles and increased EI of the lumbar erector spinae, gluteus minimus, and tibialis posterior muscles.
CONCLUSION
The properties of the trunk and lower extremity muscles may be critical for ADL, mobility and balance ability, and symptoms of PD in patients with PD.
Topics: Humans; Activities of Daily Living; Parkinson Disease; Muscle, Skeletal; Lower Extremity
PubMed: 37646863
DOI: 10.1007/s10396-023-01356-1 -
Sports (Basel, Switzerland) Aug 2023Exercises that improve muscle activation are essential for maintaining spinal stability and preventing low back pain. The purpose of this study was to compare the...
Exercises that improve muscle activation are essential for maintaining spinal stability and preventing low back pain. The purpose of this study was to compare the effects of abdominal hollowing and bracing on the activation of the core muscles in CrossFit participants using ultrasound and electromyography (EMG). Twenty-four healthy adults aged 21 to 42 years old with at least two years of CrossFit experience performed three core stability exercises (plank, side plank, bridge) with abdominal hollowing and bracing. We measured the ultrasound relative thickness of the local core muscles (transversus abdominis, internal oblique, and lumbar multifidus), and the EMG percentage of maximal voluntary contraction (MVC) of the global core muscles (rectus abdominis, external oblique, and iliocostalis lumborum). Analysis of variance tests showed that the relative thickness of the local core muscles was greater ( = 0.016) during hollowing (range from 26.8 ± 5.33 to 88.4 ± 11.9% of rest) than bracing (range from 15.9 ± 3.54 to 61.2 ± 15.9% of rest), while the EMG of the global muscles was greater ( = 0.001) in bracing (range from 24.4 ± 7.30 to 72.5 ± 9.17% of MVC) than hollowing (range from 16.4 ± 3.70 to 56.6 ± 7.65% of MVC). These results indicate that the recruitment of spinal muscles during popular exercises is achieved with both hollowing and bracing. Nevertheless, it appears that hollowing tends to recruit more of the local muscles, whilst bracing recruits more of the global muscles. The grading of the exercises varied between muscles and varied between maneuvers, especially for the surface abdominals and lumbar muscles. CrossFit practitioners can choose to use either hollowing or bracing to activate their core muscles more selectively or more appropriately, depending on the goal and purpose of the exercise.
PubMed: 37624139
DOI: 10.3390/sports11080159 -
International Journal of Exercise... 2023Preferential activation of rectus abdominis sections during crunch or leg lifts has long been disputed. The objectives of this study were to both explore the activation...
Preferential activation of rectus abdominis sections during crunch or leg lifts has long been disputed. The objectives of this study were to both explore the activation of the rectus abdominis during these exercises. This study used a randomised independent measures design utilising both EMG and diagnostic ultrasound to record changes in rectus abdominis activity. Fifteen participants each performed multiple repetitions of a 45° crunch, a 90° sit-up, and finally a 90° leg raise, sufficient for an 8-second ultrasound recording utilising M-mode of all four unilateral abdominal segments during each of the exercises, resulting in 12 images per participant. There was a significant interaction between segment number and type of exercise when testing for percent difference (F = 4.718, p < .01, η = .065). The mean thickness change of abdominis during a crunch manoeuvre was greater than the leg raise by 36.39 ± 3.21 % (p < .01). The mean thickness during the sit-up was also greater than the leg raise (32.49 ± 3.04 %). Rectus abdominis shortening and thickening was observed in all the exercises tested but was most pronounced in the abdominal crunch. Muscle recruitment seems to be biased closer to the load.
PubMed: 38288259
DOI: No ID Found -
Journal of Ultrasound in Medicine :... Jun 2024This study aimed to establish a simple and practical classification to guide the clinical treatment of diastasis recti abdominis (DRA) based on ultrasound...
OBJECTIVES
This study aimed to establish a simple and practical classification to guide the clinical treatment of diastasis recti abdominis (DRA) based on ultrasound characteristics with different severities of DRA, and to verify its clinical utility.
METHODS
We retrospectively enrolled 301 DRA patients as pilot cohort and divided into Conservative Treatment Group and Surgical Group according to clinical outcomes. A new Width-Length classification was summarized based on ultrasound measurements of the width and length of midline separation. Then, 100 DRA patients were enrolled prospectively as validation cohort, and diagnostic performance was evaluated by clinical treatment.
RESULTS
The Width-Length classification in pilot cohort was as follows: Type 1 (n = 108), open only at M3; Type 2 (n = 63), open at M3 and either M2 or M4 (inter-rectus distance at M3 <47 mm); Type 3 (n = 44), open at M3 and either M2 or M4 (inter-rectus distance at M3 ≥47 mm); Type 4 (n = 74), open at M3, along with other two sites of M1, M2, M4, or M5; Type 5 (n = 12), open at M2, M3, and M4, along with M1 or M5, or both. DRA patients in Type 1-2 were recommended for conservative treatment, and in Type 3-5 were recommended for surgical treatment (all P < .05). In the validation cohort, the accuracy of Width-Length classification in determining treatment strategy was 86.0%.
CONCLUSIONS
This study proposes a Width-Length classification based on the width and length of midline separation on ultrasound, which was validated to be simple, practical and effective in guiding DRA treatment.
PubMed: 38864261
DOI: 10.1002/jum.16508 -
Journal of ISAKOS : Joint Disorders &... Feb 2024Core muscle injury is a debilitating condition that causes chronic groin pain in athletes, particularly common in soccer players. The condition is characterised by pain...
Optimised return to play: high treatment success rate in core muscle injury with surgical release of the anterior tendon of the rectus abdominis muscle and proximal tenotomy of the adductor longus muscle.
OBJECTIVES
Core muscle injury is a debilitating condition that causes chronic groin pain in athletes, particularly common in soccer players. The condition is characterised by pain in the inguinal region and can lead to a significant number of absences from high-intensity physical activity. It is caused by repetitive overload without proper counterbalance from the abdominal muscles, hip flexors, and adductors in susceptible athletes. Surgical indications for core muscle injury consider cases where non-surgical treatments have not provided sufficient relief. The aim of this study was to assess the results of surgical intervention for core muscle injury using the technique employed by the Sports Medicine Group of (Institute of Orthopedics and Traumatology of Hospital das Clínicas - Universidade de São Paulo). The procedure involves releasing the anterior portion of the tendon of the rectus abdominis muscle near the pubic symphysis, along with proximal tenotomy of the adductor longus muscle tendon.
METHODS
This study utilised a consecutive historical cohort analysis of the medical records of 45 male athletes, of which, 75.6% were professional soccer players, who underwent surgical treatment between January 1, 2002, and December 31, 2021. The participants included active athletes aged between 18 and 40 years, with a mean age of 23.9 years, and were diagnosed with myotendinous core muscle injury. These athletes experienced pain in the pubic symphysis and adductor tendon region and had previously undergone medical treatment and physical therapy for a duration of three to six months without significant improvement.
RESULTS
The average time for athletes to return to sport after surgery was 135 days, with a majority of participants being soccer and futsal players. The surgical intervention yielded promising results, with a positive correlation between unilateral injuries and the time taken to return to sport. The complication rate was low, at 6.7%. Notably, the rate of symptom resolution was high, at 93.3%. Furthermore, the analysis indicated that the player's position on the field significantly influenced the discharge period, suggesting that the game position plays a role in the recovery process.
CONCLUSION
The combined surgical procedure involving the release of the rectus abdominis tendon and adductor longus muscle tenotomy demonstrates favourable outcomes for athletes with core muscle injury. This study provides strong support for the effectiveness of this surgical approach in managing the condition and offers a potential path to recovery and return to sports activities.
STUDY DESIGN
Cross-sectional study.
Topics: Humans; Male; Adolescent; Young Adult; Adult; Tenotomy; Rectus Abdominis; Return to Sport; Cross-Sectional Studies; Athletic Injuries; Brazil; Tendons; Chronic Pain
PubMed: 37931748
DOI: 10.1016/j.jisako.2023.10.013 -
Journal of Reconstructive Microsurgery Jun 2024Abdominal wall morbidity occurs with increased frequency following flap harvest in the obese abdomen. Its impact on patient-reported outcomes (PROs) in breast...
BACKGROUND
Abdominal wall morbidity occurs with increased frequency following flap harvest in the obese abdomen. Its impact on patient-reported outcomes (PROs) in breast reconstruction has been poorly characterized.
METHODS
A retrospective review of obese patients undergoing abdominal-based free autologous breast reconstruction was conducted over 15 years. Patient operative characteristics were recorded and outcomes were analyzed. PROs were assessed using the BREAST-Q abdominal survey.
RESULTS
In total, 75 women (108 flaps) with the mean body mass index (BMI) of 33.2 were included. Flaps included deep inferior epigastric artery perforator (24%), muscle-sparing (43%), and free transverse rectus abdominis myocutaneous flaps (f-TRAM; 33%). World Health Organization (WHO) obesity class, BMI, and flap type did not affect flap failure (1%) or complication rates. Hernia developed in 7%; all necessitated repair. Eight percent developed abdominal bulge; one was repaired. Hernia formation was associated with increased patient age ( < 0.05). Bulge formation occurred more often in f-TRAM donor sites ( = 0.005). BMI, WHO class, flap type, and mesh use were not related to hernia or bulge occurrence in either univariate or multivariate analysis. The survey response rate was 63%. Abdominal Physical Well-Being (proxy for abdominal wall function) and Satisfaction with Abdomen (patient-perceived cosmesis) were similar across flap types, age, and WHO classification groups. Patients with postoperative bulge reported higher abdominal physical well-being scores, regardless of flap type ( < 0.01). Bulge was correlated with lower satisfaction ( < 0.05).
CONCLUSION
The incidence of abdominal wall morbidity following abdominal free-tissue transfer for breast reconstruction was acceptably low in our population of obese patients. Hernia was a clinically significant complication, warranting surgical repair. Bulge was primarily a cosmetic concern and did not detract from patient-reported abdominal wall function. Age may represent an independent risk factor for hernia formation in this population.
Topics: Humans; Female; Mammaplasty; Middle Aged; Patient Reported Outcome Measures; Retrospective Studies; Abdominal Wall; Postoperative Complications; Adult; Obesity; Free Tissue Flaps; Body Mass Index; Rectus Abdominis; Aged; Perforator Flap
PubMed: 37884059
DOI: 10.1055/a-2199-4151 -
Journal of Ultrasound in Medicine :... Mar 2024The purpose of this study is to explore the application value of two-dimensional ultrasound and shear wave elastography (SWE) in the multidimensional evaluation of...
OBJECTIVE
The purpose of this study is to explore the application value of two-dimensional ultrasound and shear wave elastography (SWE) in the multidimensional evaluation of diastasis recti abdominis (DRA) during different gestational periods.
METHODS
A cohort of 202 gravidas that were examined in our hospital between June 2021 and September 2022 were selected for the purpose of the study, which included 26 cases with <14 weeks of pregnancy, 36 cases in the 14th-27th week of pregnancy, 36 cases in the 28th-34th week of pregnancy, 32 cases in the 35th-38th week of pregnancy, 45 cases at 42 days postpartum, and 27 cases at 3 months postpartum. The inter-rectus distance (IRD) and the thickness in each gestational period were measured, and Young's modulus of the rectus abdominis at different gestational periods was measured using SWE by two sonographers. The differences in IRD, thickness, and elasticity characteristics during different periods, and the correlation between rectus abdominis elasticity and IRD, thickness, body mass index (BMI), neonatal weight, and delivery mode were analyzed and compared. The consistency of SWE parameters obtained by different sonographers was also compared.
RESULTS
There were significant differences in IRD, thickness, and Young's modulus during different gestational periods (P = .000, P < .001, P < .001). Early postpartum IRD and Young's modulus did not restore to the level of early pregnancy (P < .001, P < .001), while the thickness of rectus abdominis was not significantly different from that of early pregnancy (P = .211). The Young's modulus of rectus abdominis was negatively correlated with the IRD (r = .515), positively correlated with the thickness of rectus abdominis (r = .408), and weakly negatively correlated with maternal BMI (r = -.296). There was no significant correlation with neonatal weight or delivery mode (P = .147, .648). The Bland-Altman plot showed that the two sonographers had good consistency in evaluating the elasticity of rectus abdominis by SWE.
CONCLUSION
The multidimensional evaluation of DRA by ultrasound is feasible and IRD and Young's modulus can be used to evaluate the postpartum recovery of DRA. The combination of the two can objectively reflect the severity of DRA morphology and function.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Rectus Abdominis; Ultrasonography; Postpartum Period; Elasticity Imaging Techniques; Elastic Modulus; Diastasis, Muscle
PubMed: 38050787
DOI: 10.1002/jum.16384