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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 -
Surgical and Radiologic Anatomy : SRA Apr 2021The anterior abdominal muscle wall has a strong aesthetic connotation, primarily because of the classical anatomical description of the rectus abdominis muscle in the...
PURPOSE
The anterior abdominal muscle wall has a strong aesthetic connotation, primarily because of the classical anatomical description of the rectus abdominis muscle in the collective consciousness. However, the morphological reality of the general population considerably deviates from this description. Therefore, we investigated the anthropometric characteristics correlated with the anatomy of the rectus abdominis muscle.
METHODS
We performed a computed tomography scan anatomical study of recti abdominis muscles in 86 patients with no history of abdominal surgery. We noted the transverse and anteroposterior measurements of the rectus abdominis muscle, the transverse measurement of the linea alba, and the cutaneous and muscular abdominal perimeters. We compared these morphological elements with anthropometric data (sex, age, weight, height, and body mass index [BMI]).
RESULTS
BMI was positively correlated with cutaneous abdominal perimeter (r = 0.89, p < 0.001) and muscular abdominal perimeter (r = 0.7, p < 0.001). The correlation of BMI with cutaneous abdominal perimeter was not influenced by sex (r = 0.90 and r = 0.89 in men and women, respectively). The correlation of BMI with muscular abdominal perimeter was greater in men than in women (r = 0.80 vs. r = 0.75). The muscular abdominal perimeter was more strongly correlated with the transverse measurement of the rectus abdominis muscle in men than in women (r = 0.75 vs. r = 0.59). The muscular abdominal perimeter was more strongly correlated with the linea alba in women than in men (r = 0.51 vs. r = 0.31).
CONCLUSION
The anatomy of the anterior abdominal wall correlated with anthropometric data, including BMI. Rectus abdominis muscles and linea alba structures differed between men and women.
Topics: Abdominal Wall; Adult; Age Factors; Aged; Aged, 80 and over; Body Height; Body Mass Index; Body Weight; Esthetics; Female; Humans; Male; Middle Aged; Rectus Abdominis; Retrospective Studies; Sex Factors; Tomography, X-Ray Computed
PubMed: 33399920
DOI: 10.1007/s00276-020-02655-9 -
ANZ Journal of Surgery Jun 2020Rectus abdominis is a muscle that is commonly used clinically as a muscle flap, especially in reconstructive surgery. Its intramuscular innervation, however, has rarely...
BACKGROUND
Rectus abdominis is a muscle that is commonly used clinically as a muscle flap, especially in reconstructive surgery. Its intramuscular innervation, however, has rarely been examined in detail or accurately mapped. The purpose of this study was to use biopsied, histological specimens complemented with a staining technique to investigate intramuscular nerve connections and distribution of the rectus abdominis.
METHODS
Four fresh human cadavers were included in the study and rectus abdominis was dissected bilaterally. Nerve sections innervating the rectus abdominis were biopsied and histologically processed. Sections were viewed under the microscope, and axons within each fascicle were counted using imaging software. All specimens were stained with a modified Sihler's staining technique. Intramuscular innervation was observed and the number as well as distribution was recorded.
RESULTS
Macroscopically stained specimens showed that the eighth, ninth, 10th and 12th intercostal nerves innervated the eight muscle bellies of rectus abdominis. The greatest number of minor nerve branching as well as intramuscular nerve communications originated from nerve roots T9 and T10. Minor nerve branches crossed tendinous intersections to communicate with adjacent nerves and innervate adjacent muscle bellies. Nerves originating from T9 had the greatest number of nerve fascicles and the highest axon count in each cadaver.
CONCLUSION
The rectus abdominis is divided into four compartments with each receiving its own independent nerve supply. Minor nerve branches crossed tendinous intersections to communicate with adjacent muscle bellies and nerves suggesting that rectus abdominis can be used as a whole in innervated free flap transfer procedures.
Topics: Cadaver; Humans; Plastic Surgery Procedures; Rectus Abdominis; Surgical Flaps; Tendons
PubMed: 31957163
DOI: 10.1111/ans.15682 -
Annali Italiani Di Chirurgia 2022Rectus sheath hematoma is the accumulation of blood within rectus abdominis muscle. The aim of this study was to investigate the clinical presentation, diagnostic...
OBJECTIVES
Rectus sheath hematoma is the accumulation of blood within rectus abdominis muscle. The aim of this study was to investigate the clinical presentation, diagnostic methods, treatment strategy, and outcomes of patients diagnosed with rectus sheath hematoma.
METHODS
Patients diagnosed and treated for spontaneous rectus sheath hematoma between January 2014 and December 2019 were included in the study.
RESULTS
A total of 11 patients were diagnosed as spontaneous rectus sheath hematoma, with a median age of 63.5 ± IQR (55.5-73.25). 8 patients were treated by transfusion and medical therapy, while two patients underwent surgery and drainage. One patient was treated with arterial embolization. No mortality was encountered.
CONCLUSION
Anticoagulant therapy was a major risk factor. Treatment is mostly based on supportive care to maintain hemodynamic stability.
KEY WORDS
Abdominal pain, Hematoma, Interventional radiology, Rectus sheath.
Topics: Abdominal Pain; Anticoagulants; Hematoma; Humans; Muscular Diseases; Rectus Abdominis
PubMed: 36155938
DOI: No ID Found -
Plastic and Reconstructive Surgery Dec 2021Vascularized tissue for obliteration of large pelvic dead spaces created by extirpative surgery has been shown to reduce complication rates. As more extensive resections...
SUMMARY
Vascularized tissue for obliteration of large pelvic dead spaces created by extirpative surgery has been shown to reduce complication rates. As more extensive resections are performed robotically, plastic surgeons have been challenged to reconstruct the resulting defects using a minimally invasive approach. The goal of this study was to report the authors' experience with robotic harvest of the rectus abdominis muscle for reconstruction of pelvic defects. The authors conducted a retrospective case series of patients who underwent robotic flap harvest following robotic extirpative surgery at their institution. Patient demographics, surgical characteristics, and postoperative outcomes were collected. These were compared to a retrospective cohort of patients who underwent open rectus abdominis muscle harvest. The authors identified seven male patients who underwent robotic flap harvest for pelvic reconstruction between 2013 and 2019. Their mean age was 66 ± 6 years and mean body mass index was 31 ± 5 kg/m2. Six patients (86 percent) had a history of radiation therapy and five patients (71 percent) received hormone therapy or chemotherapy. Surgical-site complications occurred in two patients. One patient developed ventral hernia. The donor-site complication rate was 19 percent (n = 18) in patients who underwent open rectus abdominis muscle harvest (n = 95). This study demonstrates the safety, efficacy, and reproducibility of robotic harvest of the rectus abdominis muscle in complex, multidisciplinary, minimally invasive pelvic surgery. The technique avoids violation of the anterior rectus sheath and wound complications related to open flap harvest, and early experience suggests reduced donor-site morbidity.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Aged; Humans; Male; Middle Aged; Pelvic Neoplasms; Postoperative Complications; Plastic Surgery Procedures; Rectus Abdominis; Reproducibility of Results; Retrospective Studies; Robotic Surgical Procedures; Surgical Flaps; Surgical Wound; Tissue and Organ Harvesting; Treatment Outcome
PubMed: 34847128
DOI: 10.1097/PRS.0000000000008592 -
The Journal of Sports Medicine and... Sep 2022The prepubic aponeurotic complex anatomy (PPAC) consists in a fibrous capsule, which anteriorly lines the pubic symphysis, formed by the interconnection of different... (Review)
Review
The prepubic aponeurotic complex anatomy (PPAC) consists in a fibrous capsule, which anteriorly lines the pubic symphysis, formed by the interconnection of different anatomical structures. Research of the studies (original articles, case series and review articles) was conducted without publication data limitation or language restriction on the following databases: PubMed/MEDLINE, Scopus, ISI, EXCERPTA. To date, evidence from the literature suggests that: 1) the PPAC is formed by interconnection between the tendons of the adductor longus, adductor brevis, gracilis and pectineus muscles, the aponeurosis of rectus abdominis, pyramidalis and external oblique muscles, the articular disc, the anterior pubic periostium and by the superior, inferior and anterior pubic ligament; 2) the PPAC clinical presentation may mimic a adductor longus tendon injury, the MRI examination can help to differentiate the two different clinical frameworks; 3) the PPAC injuries show a typical MRI presentation which must be differentiated from other similar but clinically different imaging frameworks; 4) the PACC injury can be treated conservatively, with medical therapies or surgically. This narrative structured review provides an insight into the PPAC the anatomy, the clinical presentation, the imaging and the treatment of the PPAC injuries.
Topics: Aponeurosis; Athletic Injuries; Humans; Magnetic Resonance Imaging; Pubic Symphysis; Rectus Abdominis; Tendons; Thigh
PubMed: 36043265
DOI: 10.23736/S0022-4707.21.12669-6 -
Journal of Sports Science & Medicine Dec 2022A side-to-side difference in the muscle size of the rectus abdominis has been suggested to increase the strain injury risk. Attenuating the difference in size of the...
A side-to-side difference in the muscle size of the rectus abdominis has been suggested to increase the strain injury risk. Attenuating the difference in size of the rectus abdominis may decrease the injury risk. To explore ways to highly activate one side of the rectus abdominis, we aimed to clarify the activity levels of both sides of the muscle during asymmetric abdominal exercises. Fifteen male sprinters performed the following five asymmetric exercises for the right and left sides: (i) sit-up twist, (ii) oblique leg raise, (iii) side bridge, (iv) side bridge roll out with the elbow, and (v) side bridge roll out with the foot. Side bridge roll out with the elbow and that with the foot were performed using a wheeled platform. During the exercises, electromyographic signals were recorded bilaterally from the upper, central, and lower portions of the rectus abdominis. We calculated the root mean square of electromyograms during the concentric and eccentric phases of the exercises and normalized to that during maximal voluntary contractions. In all portions of the rectus abdominis, the root mean squares of electromyograms were significantly higher in the moving side than in the non-moving side during the concentric and eccentric phases of the side bridge, the side bridge roll out with the elbow and that with the foot (all < 0.01), but not in sit-up twist or oblique leg raise. The root mean squares of electromyograms of all portions of the rectus abdominis in the moving side were significantly higher in the side bridge roll out with the elbow and that with the foot than in the side bridge during both phases (all < 0.01). The results suggest that the application of the wheeled platform to side bridge is useful to highly activate one side of the rectus abdominis.
Topics: Humans; Male; Abdominal Muscles; Exercise Therapy; Exercise; Electromyography; Rectus Abdominis
PubMed: 36523892
DOI: 10.52082/jssm.2022.493 -
Surgical and Radiologic Anatomy : SRA Apr 2020The newborn umbilicus is provided by a fibrous ring after closure with a scar at the bottom. Since it is believed to be embedded in the linea alba, a specific connection...
PURPOSE
The newborn umbilicus is provided by a fibrous ring after closure with a scar at the bottom. Since it is believed to be embedded in the linea alba, a specific connection with the rectus sheath was not yet hypothesized for the umbilicus. However, there are no or few descriptions about the development and growth.
METHODS
We histologically examined 28 fetuses at 8-40 weeks: 6 fetuses at 8 weeks, 12 at 10-14 weeks and 10 at 31-40 weeks.
RESULTS
An initial rectus sheath issued a linear mesenchymal condensation toward the umbilical cord at 10-14 weeks and, an established sheath provided a fibrous band around the umbilical cord at 31-40 weeks. The rectus sheath margins made an acute turn toward the skin at the superior and lateral rims of umbilicus and dispersed into a loose tissue of the cord. In contrast, the sheath margin changed its direction gradually to the superficial side at the inferior rim and inserted at a border between the skin epidermis and a mesothelium-like covering of the cord. The developing umbilical ring contained no or few elastic fibers.
CONCLUSION
Instead of the underdeveloped linae alba, the rectus sheath seemed to be tightly connected with the umbilicus at birth. Rather than an expected elasticity, the rectus muscle contraction was likely to play a critical role in the closure after birth. Via the umbilical ring, the fetal rectus sheath also seemed to tightly connect with the skin at the inferior rim of umbilicus.
Topics: Fetal Development; Fetus; Gestational Age; Humans; Rectus Abdominis; Umbilicus
PubMed: 31897654
DOI: 10.1007/s00276-019-02398-2 -
Minerva Chirurgica Oct 2020Abdominal rectus diastasis (RD) is characterized by thinning and widening of the linea alba, combined with laxity of the ventral abdominal musculature. This condition is... (Review)
Review
Abdominal rectus diastasis (RD) is characterized by thinning and widening of the linea alba, combined with laxity of the ventral abdominal musculature. This condition is associated with bulging of abdominal content, and it is mostly acquired during pregnancy or obesity. Symptoms include pain and discomfort in the abdomen, musculoskeletal and uro-gynecological problems in addition to negative body image and impaired quality of life. In this review we present current knowledge on the novel surgical mini-invasive techniques for treatment of RD. The aim of our study is to discuss the use of a standard classification to define pathological RD and possible indications for a minimally invasive repair, considering complications, patients' satisfaction and recurrence rate. A PubMed search of the literature has been conducted in January 2020 including the most recent articles using the following criteria among the interventions for RD: mini-invasive surgery, laparoscopic, endoscopy and robotic procedures. Minimally invasive surgical treatment options for rectus diastasis are poorly investigated and indications for repair are still debated. Guidelines are mandatory to standardize surgical management of RD.
Topics: Diastasis, Muscle; Herniorrhaphy; Humans; Laparoscopy; Minimally Invasive Surgical Procedures; Pneumoperitoneum, Artificial; Rectus Abdominis; Video-Assisted Surgery
PubMed: 33210526
DOI: 10.23736/S0026-4733.20.08461-8 -
Hernia : the Journal of Hernias and... Aug 2021Meshes clearly have improved outcomes for tissue approximation over suture repairs for incisional hernias. A knowledge gap exists as to the surgical complication rate...
PURPOSE
Meshes clearly have improved outcomes for tissue approximation over suture repairs for incisional hernias. A knowledge gap exists as to the surgical complication rate and post-operative outcomes of a mesh rectus diastasis repair with a narrow well-fixed mesh that simultaneously narrows the rectus muscles and closes the widened linea alba.
METHODS
Inclusion criteria for mesh abdominoplasty were patients who (1) underwent a retrorectus planar mesh for repair of rectus diastasis (2) did not have a concurrent incisional hernia and (3) underwent skin tailoring as part of a cosmetic aspect of their care. The primary endpoint was surgical site occurrence (SSO) at any time after surgery as determined with review of their office and hospital medical records. Secondary endpoints included the length and complexity of the return to the operating room for any reason, non-surgical complications, readmission, post-operative recovery, surgical site infection, recurrence/persistence of abdominal wall laxity, and soft tissue revision rates.
RESULTS
SSO rate was 0% for the 56 patients who underwent this procedure. There were 40 women and 16 men. Superficial infections requiring oral antibiotics were required in three patients. One was a drain site erythema, one was for a superficial stitch abscess, and the third was for a mesh strip knot infection 6 months after the procedure. One patient underwent further tightening of the abdominal wall. Rates of soft tissue revision in the office for improved cosmesis were 23% in women and 6% in men.
CONCLUSION
Repair of rectus diastasis with a narrow well-fixed mesh and concurrent skin abdominoplasty is a well-tolerated and reliable procedure with low recurrence and low SSO in the manner described. It is a procedure that works for both female and male pattern rectus diastasis, and has become our procedure of choice for moderate and severe rectus diastasis.
Topics: Abdominal Wall; Abdominoplasty; Female; Hernia, Ventral; Herniorrhaphy; Humans; Male; Rectus Abdominis; Recurrence; Surgical Mesh
PubMed: 34342745
DOI: 10.1007/s10029-021-02461-1