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Journal of Plastic Surgery and Hand... 2023The extended vertical rectus abdominis myocutaneous (eVRAM) flap has been proposed for reconstruction of large pelviperineal defects where traditional VRAM flap could be...
The extended vertical rectus abdominis myocutaneous (eVRAM) flap has been proposed for reconstruction of large pelviperineal defects where traditional VRAM flap could be insufficient. To compare the dimensions of VRAM and eVRAM flaps an anatomical study was performed. Ten VRAM and ten eVRAM flaps were dissected in ten fresh adult cadavers. Length, width and volume of all the flaps were measured. Length and volume were significantly larger in eVRAM flap compared to VRAM flap (36.55 cm 30.15, =.005; and 315.5 244 mL, =.012, respectively). No differences were observed in flap width. The eVRAM flap could be a better option than traditional VRAM for reconstruction of big pelviperineal defects when bulkier tissue, larger skin paddle and/or longer arch of rotation are needed for reconstruction.
Topics: Adult; Humans; Myocutaneous Flap; Rectus Abdominis; Skin; Cadaver; Foot
PubMed: 35034570
DOI: 10.1080/2000656X.2021.2024554 -
Hernia : the Journal of Hernias and... Aug 2021More interest in the treatment of rectus diastasis has been evoked lately. Following the postpartum females from a great distance, the middle-aged males living with... (Review)
Review
PURPOSE
More interest in the treatment of rectus diastasis has been evoked lately. Following the postpartum females from a great distance, the middle-aged males living with obesity are the second most common group of rectus diastasis patients. Although gender differences are considered frequently in regard to cosmetic appearance and symptoms, it is less obvious in classifications and subsequent treatment strategies. Is a unisex approach of rectus diastasis still applicable? The lack of a firm answer warrants this review of the current literature.
METHODS
An explorative free-text multi-database bibliographic search (Pubmed/CENTRAL/EMBASE/PEDro/Scholar) was performed with the focus on the rectus diastasis in males. Anticipating the limited references, the design was a non-systematic review. All studies, regardless of study type, language or time period, describing etiology, symptoms, classification and/or treatment options were eligible for inclusion. From the articles retrieved out of this search, additional references were identified by a manual search among the cited references.
RESULTS
The multi-database search resulted in a total of 7633 records. Based on the title and abstract 95 records were full text assessed for eligibility. Eleven studies were identified as relevant, six by cross-reference and another four by hand-search were added to provide an insight in gender-specific aspects in rectus diastase. Hereditary causes are differences in collagen-like composition of types and concomitant abdominal aneurysm as well as gender differences in the linea alba architecture. Acquired etiology is distributed into both absolute pressure by visceral obesity and relative pressure caused by weight lifting or improper exercises. Furthermore, the impact of muscle thickness and age are considered as influencers of biomechanics. Gender differences can also play a role in symptoms of body image and core stability. It is known that there are anatomical differences between male and female persons; more transverse fibers are found in infra-umbilical region in women. In classifications the awareness of male rectus diastasis is limited, treatment outcome studies are scarce on males.
CONCLUSION
An overview of male-specific aspects of rectus diastasis is provided, underlining that key aspects surrounding rectus diastasis in males differ from females. Although males are the minority of rectus diastasis patients, we recommend that the male rectus diastasis as a concept should be specifically acknowledged in classifications systems and study outcome reporting to evaluate this subgroup more accurately in the future.
Topics: Abdominal Wall; Exercise; Female; Herniorrhaphy; Humans; Male; Middle Aged; Rectus Abdominis
PubMed: 34297251
DOI: 10.1007/s10029-021-02467-9 -
Physiotherapy Theory and Practice Oct 2022Diastasis recti abdominis (DRA) and pelvic floor dysfunction (PFD) occurs commonly with aging; however, little is known about what leads to these changes.
INTRODUCTION
Diastasis recti abdominis (DRA) and pelvic floor dysfunction (PFD) occurs commonly with aging; however, little is known about what leads to these changes.
OBJECTIVE
We aimed to investigate and compare the presence or absence of DRA and PFD in peri- and postmenopausal women.
METHODS
This cross-sectional study involved 150 participants who answered questions on their sociodemographic and clinical profiles related to urinary and fecal incontinence and pelvic organ prolapse. Diastasis recti abdominis was diagnosed with a digital caliper.
RESULTS
Supra-umbilical diastasis occurred in 37.3% of cases, and 78.6% of participants with DRA had PFD. No significant differences existed between participants with and without DRA in terms of background and clinical variables. However, participants with DRA were 2.6 times more likely to have PFD than participants without DRA. Furthermore, the presence of DRA was significantly shown to be a risk factor for PFD on binary logistic regression analyses ( = .01, OR = 3.2).
CONCLUSIONS
This cross-sectional study suggests that DRA is a predictive factor of PFD in women aged over 50 years.
Topics: Cross-Sectional Studies; Female; Humans; Middle Aged; Muscular Diseases; Pelvic Floor; Pelvic Organ Prolapse; Postmenopause; Rectus Abdominis
PubMed: 33283590
DOI: 10.1080/09593985.2020.1849476 -
Journal of Plastic Surgery and Hand... Apr 2021Vulvoperineal defects resulting from surgical treatment of (pre)malignancies may result in reconstructive challenges. The vertical rectus abdominis muscle flap and, more...
Vulvoperineal defects resulting from surgical treatment of (pre)malignancies may result in reconstructive challenges. The vertical rectus abdominis muscle flap and, more recently, the fasciocutaneous lotus petal flap are often used for reconstruction in this area. The goal of this review is to compare the postoperative complications of application of these flaps. A comprehensive literature search of the PubMed, MEDLINE and Cochrane Library databases was performed until 6 June 2020. Search terms included the lotus petal flap, vertical rectus abdominis muscle flap and the vulvoperineal area. Articles were independently screened by two researchers according to the PRISMA-guidelines. A total of 1074 citations were retrieved and reviewed, of which 55 were included for full text analysis. Following lotus petal flap reconstructions, the complication rate varied from 0.0% to 69.9%, with more complications concerning the recipient site compared with the donor site complications (26.0% versus 4.5%). Following vertical rectus abdominis muscle flap reconstructions the complication rate varied between 0.0% and 85.7% with almost twice the number of recipient site complications compared to donor site complications (37.1% versus 17.8%). Overall, the lotus petal flap has lower complication rates at both the donor and the recipient site compared with the vertical rectus abdominis muscle flap. When both options seem viable, the lotus petal flap procedure may be preferred on the basis of the reported lower complication rates. APE: abdominoperineal excision; ELAPE: extra levator abdominoperineal excision; LP flap: lotus petal flap; NIH: National Institute of Health; NR: not reported; RCT: randomized controlled trial; VRAM flap: vertical rectus abdominis myocutaneous flap.
Topics: Female; Humans; Myocutaneous Flap; Perineum; Postoperative Complications; Rectus Abdominis; Surgical Flaps; Vulva
PubMed: 33054472
DOI: 10.1080/2000656X.2020.1828902 -
Journal of Ultrasound Mar 2024The plank is a common exercise used to evaluate core function. Surface electromyography (sEMG) and ultrasound can be used simultaneously to measure muscle activity. We...
AIMS
The plank is a common exercise used to evaluate core function. Surface electromyography (sEMG) and ultrasound can be used simultaneously to measure muscle activity. We aimed to compare the %-thickness and %-activation during the plank performed on three surfaces and to determine agreement and relationship between rectus abdominis (RA) %-thickness of a rested tabletop position and %-activation normalized to quiet tabletop position during the plank on three surfaces.
METHODS
In this cross-sectional study, ultrasound and sEMG measured RA muscle function during the first 5-s and last 5-s of a plank performed on a table, yoga mat, and fitness ball. A repeated measures ANOVA compared differences in %-thickness change and Friedman's tests compared differences in %-activation, alpha set a priori p ≤ 0.05. Bland-Altman plots measured agreement between instruments. Spearman's rho determined relationships between instruments.
RESULTS
There was no difference between %-thickness change across surfaces during the first 5-s or last 5-s, or between %-activation during the last 5-s. The %-activation of the RA during the first 5-s performed on the fitness ball was higher than the table and yoga mat (p < 0.001). Ultrasound and sEMG had weak relationships across all surfaces (ρ = - 0.078 to 0.116).
CONCLUSION
The first 5-s of the plank performed on the fitness ball requires a greater RA activation. Ultrasound could not detect changes in %-thickness of the RA during the plank which may be influenced by the type of contraction. Comparison between these measurement tools during isometric exercise should be used with caution.
Topics: Humans; Rectus Abdominis; Cross-Sectional Studies; Electromyography; Exercise
PubMed: 36454532
DOI: 10.1007/s40477-022-00750-8 -
Supportive Care in Cancer : Official... May 2020To evaluate the trophic changes in rectus abdominis and psoas muscles in patients who underwent open or laparoscopic rectum resection for rectal cancer.
PURPOSE
To evaluate the trophic changes in rectus abdominis and psoas muscles in patients who underwent open or laparoscopic rectum resection for rectal cancer.
METHODS
We retrospectively analyzed preoperative staging computerized tomographies (CT) and postoperative first oncological follow-up CTs of the patients who underwent low anterior resection (LAR) for rectal cancer from 2010 through 2015. We measured cross-sectional area of left and right rectus abdominis muscles from two levels (above and below umbilicus) where they are widest and psoas muscle at mid-level of the fourth lumbar vertebral body in axial CT images and compared preoperative and postoperative measurements. We investigated the effects of age, sex, administration of preoperative chemoradiotherapy (CRT), type of surgery (open or laparoscopic), or construction of a diverting ileostomy on cross-sectional muscle area changes.
RESULTS
After applying inclusion and exclusion criteria 60 patients found to be eligible for the study. Muscle areas of all measurement sites were reduced postoperatively compared to paired preoperative values. There was no significant effect of age, sex, administration of preoperative CRT, type of surgery (open or laparoscopic), or construction of a diverting ileostomy to muscle cross-sectional area reductions.
CONCLUSION
Cross-sectional areas of the rectus abdominis and the psoas muscles of rectal cancer patients reduces following rectum resection which indicates atrophy of these muscles. Clinicians should be aware of this problem and focus on prevention of muscle atrophy during the treatment of rectal cancer patients.
Topics: Adult; Aged; Aged, 80 and over; Chemoradiotherapy; Female; Humans; Ileostomy; Laparoscopy; Male; Middle Aged; Muscular Atrophy; Postoperative Period; Psoas Muscles; Rectal Neoplasms; Rectus Abdominis; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 31489510
DOI: 10.1007/s00520-019-05062-y -
Journal of Plastic, Reconstructive &... Jun 2022The vertical rectus abdominis myocutaneous (VRAM) flap is one of the options for soft-tissue reconstruction in the groin and thigh. The aim of this study is to evaluate...
BACKGROUND
The vertical rectus abdominis myocutaneous (VRAM) flap is one of the options for soft-tissue reconstruction in the groin and thigh. The aim of this study is to evaluate the clinical outcomes, risk factors for complications, and the utility of using mesh to prevent abdominal hernia.
METHODS
A retrospective review of patients who underwent VRAM flap reconstruction to reconstruct proximal thigh and groin defects from 1997 to 2018 was performed. Data regarding patient demographics, surgical characteristics, and postoperative outcomes were collected. Proportional hazard regression analysis was performed to assess the association of the risk of recipient site complications. A systematic review was performed to assess the outcomes and summarize the evidence from published studies.
RESULTS
Fifty-three patients were identified and included in this study. In most of the cases, the procedures were performed after tumor resection (77%) and in the rest of the cases, they were performed for chronic complicated wounds (23%). Twenty-five (47.2%) patients developed complications. Intraoperative and postoperative radiotherapy, chronic kidney disease, history of prior tumor resection, and reconstructions of chronic complicated wounds were associated with an increased risk of recipient site complications. A systematic review identified 9 articles, for a total of 189 reconstructions. The pooled complications and failure rates were 31.2% and 2.1%, respectively. Stratified analysis showed that the rate of abdominal hernia was similar in patients with mesh (16.7%) and in patients with primary closure only (15.1%; p = 0.761).
CONCLUSION
Defects in the groin or proximal thigh can be treated successfully with the VRAM flap. Although wound complications and hernia rates are high, the reconstruction failure rate is low.
Topics: Groin; Hernia, Abdominal; Humans; Myocutaneous Flap; Neoplasms; Postoperative Complications; Plastic Surgery Procedures; Rectus Abdominis; Retrospective Studies; Thigh
PubMed: 35148978
DOI: 10.1016/j.bjps.2022.01.015 -
Physiotherapy Theory and Practice Nov 2022Urinary incontinence (UI) is a common pelvic floor dysfunction in pregnancy. The relationship between biomechanical changes and pregnancy-related UI has not been fully...
INTRODUCTION
Urinary incontinence (UI) is a common pelvic floor dysfunction in pregnancy. The relationship between biomechanical changes and pregnancy-related UI has not been fully elucidated.
OBJECTIVE
To investigate the association of various musculoskeletal and anthropometric changes in pregnancy that affect gestational UI.
METHODS
The study was conducted with 275 pregnant women. Ninety-three, 110 and 72 women were in first, second and third trimesters, respectively. Incontinence Impact Questionnaire for UI, Urogenital Distress Inventory-Short Form and Incontinence Severity Index were applied. Lumbar lordosis measurement was performed by Baseline Bubble Inclinometer while diastasis recti abdominis (DRA) measurement was carried out by finger-width method. Manual muscle test for rectus abdominis and right and left external oblique abdominal muscles, and Benign joint hypermobility test with Beighton scoring method were also applied as musculoskeletal measurements. Tape measurement at the waist, umbilical and hip levels, caliper with bi-iliac and bi-trochanteric diameters were also recorded as anthropometric measurements.
RESULTS
Significant associated factors for UI were: umbilical DRA (OR = 1.57; = .012); rectus abdominis muscle strength (values of 3 and below, OR = 1.2; = .014); umbilical environment (OR = 1.1; = .029); bi-iliac diameter (OR = 1.1; = .05;) and bi-trochanteric diameter (OR = 1.3; = .05), respectively.
CONCLUSION
Changing musculoskeletal and anthropometric characteristics of pregnant women should be taken into consideration in UI follow-up during pregnancy.
Topics: Abdominal Muscles; Anthropometry; Diastasis, Muscle; Female; Humans; Muscular Diseases; Pregnancy; Rectus Abdominis; Urinary Incontinence
PubMed: 33522357
DOI: 10.1080/09593985.2021.1878568 -
Journal of Bodywork and Movement... Jan 2020This study explores the anatomical relation of the rectus abdominis muscles with the anterior and posterior rectus sheaths. The elastic behavior of these fascial sheets... (Observational Study)
Observational Study
INTRODUCTION
This study explores the anatomical relation of the rectus abdominis muscles with the anterior and posterior rectus sheaths. The elastic behavior of these fascial sheets is also assessed. Both of these analyses form an anatomic-biomechanical basis for diagnosis and treatment, especially in relation to diastasis recti abdominis (DRA).
METHOD
Fundamental observational, biomechanical study. Seven post-mortem, embalmed human specimens were dissected. The abdominal muscles and the fascial sheets of the abdominal wall were dissected. 4 × 4 cm samples of the anterior and posterior rectus sheaths were loaded in longitudinal and transverse direction, while recording elongation by means of a displacement sensor. The main outcome measures were anatomical descriptions and elongation of fascia samples in mm (mean and standard ± deviation).
RESULTS
In longitudinal direction the posterior rectus sheath samples stretched over 1.67 ± 0.48 mm, while in transverse direction the mean stretch was 0.29 ± 0.18 mm (p = 0.001). In contrast, no significant difference between longitudinal (0.78 ± 0.43 mm) and transversal displacement (0.50 ± 0.23 mm) was observed in the anterior rectus sheath (p = 0.56).
DISCUSSION AND CONCLUSION
The posterior rectus sheath is functionally more related to the transverse abdominis muscle than to the rectus abdominis muscle. From this connection, in combination with the specific stiffness of the posterior fascia in the lateral direction, it is assumed that the transverse abdominis muscles play an important role in the etiology but also in reduction of DRA. The transverse abdominis and rectus abdominis muscles collaborate in support of the abdominal wall.
Topics: Aged; Aged, 80 and over; Biomechanical Phenomena; Dissection; Fascia; Female; Humans; Male; Prune Belly Syndrome; Rectus Abdominis
PubMed: 31987535
DOI: 10.1016/j.jbmt.2019.10.015 -
Academic Radiology Mar 2022The rectus abdominis muscle exhibits early and significant muscle atrophy, which has largely been characterized using ultrasound measured muscle thickness. However, the...
RATIONALE AND OBJECTIVES
The rectus abdominis muscle exhibits early and significant muscle atrophy, which has largely been characterized using ultrasound measured muscle thickness. However, the validity of rectus abdominis muscle thickness as a metric of muscle size has not been established, limiting precise interpretation of age-related changes. In a heterogeneous cohort of women and men, our objectives were to: (1) evaluate the association between rectus abdominis muscle thickness and cross-sectional area (CSA), and (2) examine if the visceral adipose tissue (VAT) compartment confounds the validity of rectus abdominis muscle thickness.
MATERIALS AND METHODS
Abdominal computed tomography scans of the third lumbar vertebrae from clinical and healthy populations were used to evaluate rectus abdominis thickness and CSA, and VAT CSA. Computed tomography scans were utilized due to the limited field of view of ultrasound imaging to capture the rectus abdominis CSA.
RESULTS
A total of 348 individuals (31% women) were included in this analysis, with a mean ± standard deviation age and body mass index of 51.2 ± 15.4 years and 28.0 ± 5.1 kg/m, respectively. Significant correlations were observed between rectus abdominis thickness and CSA for women (r = 0.758; p < 0.001) and men (r = 0.688; p < 0.001). Independent of age, VAT CSA was negatively associated with rectus abdominis thickness in men (p = 0.011), but not women (p = 0.446).
CONCLUSION
These data support the use of rectus abdominis muscle thickness as a measurement of muscle size in both women and men; however, the VAT compartment may confound its validity to a minor extent in men.
Topics: Body Mass Index; Female; Humans; Intra-Abdominal Fat; Male; Rectus Abdominis; Tomography, X-Ray Computed; Ultrasonography
PubMed: 34253439
DOI: 10.1016/j.acra.2021.06.005