Correlations of the rectus abdominis muscle anatomy with anthropometric measurements.

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.

Preoperative and Postoperative Assessment of Rectus Abdominis Muscle Size and Function following DIEP Flap Surgery.

BACKGROUND: Prospective evaluation of rectus abdominis muscle function after deep inferior epigastric artery perforator (DIEP) flap breast reconstruction is limited. Elimination of muscle harvest with this procedure is theoretically associated with preservation of rectus abdominis function and minimization of abdominal wall morbidity. In this study, the authors evaluate the change in rectus abdominis muscle size and function after DIEP flap surgery. METHODS: Patients undergoing unilateral DIEP flap surgery were recruited prospectively. Using computed tomography, the change in preoperative to postoperative rectus abdominis muscle size was compared between the operative side rectus abdominis muscle and the contralateral, nonoperative control rectus abdominis. Postoperative muscle integrity and contractility were evaluated using ultrasound by comparing the change in rectus abdominis muscle dimensions between contractile and relaxed states. The BREAST-Q was used to score patients' subjective satisfaction. Clinical and radiographic hernia rates were also calculated. RESULTS: Analysis of 26 paired rectus abdominis muscles revealed no significant change in muscle size from preoperative to postoperative values. Furthermore, dimensional change from contractile to relaxed states postoperatively was similar for paired operative and nonoperative rectus abdominis muscles. BREAST-Q scores indicated a high degree of satisfaction in abdominal well-being, breast satisfaction, and surgical experience domains. There were no clinical or radiographic abdominal wall hernias noted. CONCLUSIONS: The DIEP flap is an effective surgical procedure with minimal abdominal wall morbidity that is associated with no measurable loss in rectus abdominis size and contractile function postoperatively. Patients are highly satisfied with their abdominal function postoperatively using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Defining the Anatomy of the Tendinous Intersections of the Rectus Abdominis Muscle and Their Clinical Implications in Functional Muscle Neurotization.

PURPOSE: Little is known about the definitive course of the tendinous intersections from anterior to posterior through the rectus abdominis (RA) muscle. The implications of a full thickness intersection may have effects on the ability to neurotize the RA. We hypothesized that these tendinous inscriptions would be fully adherent to the anterior rectus sheath, but there would be an incomplete penetrance into the posterior surface, thereby allowing for muscle fibers and neurovascular structures to run the entire course of the RA muscle. METHODS: Fifty-five cadaveric, hemiabdominal walls were evaluated. Measurements were taken of RA muscle thickness, depth of penetrance of the tendinous intersections, and intersection thickness. RESULTS: Of the 32 cadavers, 2 had 4 paired tendinous intersections and the remaining 30 cadavers had 3 paired tendinous intersections. Rectus abdominis muscle belly tended to be thicker at midbelly, between intersections than at the level of the corresponding intersection. A total of 168 tendinous intersections were assessed. Thirty (18%) of these inscriptions proved to be full thickness extending from anterior rectus sheath to posterior rectus sheath without any intervening muscle or neurovascular structures. Twenty-three (42%) of the 55 hemiabdomens assessed had at least one full-thickness tendinous intersection. CONCLUSIONS: The majority of RA muscles have 3 paired tendinous intersections. Most intersections are incomplete and only encompass the anterior rectus sheath. However, there may be a higher percentage of full-thickness intersections than previously appreciated and the clinical relevance behind these remains unclear.

Muscle thickness of the pectoralis major and rectus abdominis and level of physical activity in chronic hemodialysis patients / Espessura muscular do pectoralis major e do rectus abdominis e nível de atividade física em pacientes em hemodiálise crônica

Abstract Introduction: Patients on chronic hemodialysis tend to lose lean body mass and have sedentary behavior. Objective: To compare the level of physical activity and the morphology of the muscles pectoralis major and rectus abdominis of patients on hemodialysis with healthy subjects. Methods: We studied 17 patients and 17 healthy individuals. Muscle thickness were evaluated by ultrasound, and the level of physical activity by the International Physical Activity Questionnaire (IPAQ), long version. Results: The patients had lower thicknesses of the pectoralis major (5.92 ± 0.35 mm vs. 8.35 ± 0.62 mm, p < 0.001) and rectus abdominis (0.96 ± 0.10 mm vs. 2 21 ± 0.40 mm, p < 0.001) compared to healthy subjects. Patients were physically less active than healthy individuals: 1502.55(788.19-2513.00) MET-minutes/week vs. 2268.0(1680.0-4490,8) MET-minutes/week (p = 0.006); the weekly caloric expenditure of patients was also lower: 1384.0(480,7-2253.7) kcal/kg/week vs. 1680.0(1677.4-4950.0) kcal/kg/week (p = 0.010). The average time spent sitting per week of the patients was higher than in healthy subjects (394.0 ± 33.1 min/day vs. 293.0 ± 38.6, p = 0.009) as well as the average time spent sitting during weekend (460.0 ± 40.1 vs. 201.0 ± 10.7, p = 0.003). Conclusion: Chronic renal failure patients on hemodialysis have sedentary behavior and lower muscle thickness of the trunk.

Resumo Introdução: Pacientes que realizam hemodiálise crônica tendem a perder massa magra e ter comportamento sedentário. Objetivo: Comparar o nível de atividade física e morfologia dos músculos peitoral maior e reto do abdômen de pacientes que realizam hemodiálise com indivíduos saudáveis. Métodos: Foram estudados 17 pacientes e 17 indivíduos saudáveis. As espessuras musculares foram avaliadas por meio de ultrassonografia, e o nível de atividade física pelo Questionário Internacional de Atividade Física versão longa (IPAQ). Resultados: Os pacientes apresentaram menores espessuras do peitoral maior (5,92 ± 0,35 mm vs. 8,35 ± 0,62 mm, p < 0,001) e de reto abdominal (0,96 ± 0,10 mm vs. 2,21 ± 0,40 mm, p < 0,001) comparados aos sujeitos saudáveis. Os pacientes foram fisicamente menos ativos que os indivíduos saudáveis: 1502.55(788.19-2513.00) MET-minutos/semana vs. 2268.0(1680.0-4490,8) MET-minutos/semana (p = 0,006); o gasto calórico semanal dos pacientes também foi menor: 1384,0(480,7-2253.7) kcal/kg/semana vs. 1680,0(1677,4-4950,0) kcal/kg/semana (p = 0,010). O tempo médio gasto sentado por semana dos pacientes foi maior que dos sujeitos saudáveis (394,0 ± 33,1 min/dia vs. 293,0 ± 38,6, p = 0,009), assim como o tempo médio gasto sentado durante o fim de semana (460,0 ± 40,1 vs. 201,0 ± 10,7, p = 0,003). Conclusão: Pacientes renais crônicos em hemodiálise apresentam comportamento sedentário e menores espessuras musculares do tronco.

The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept.

PURPOSE: Adductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and perisymphyseal anatomy can lead to difficulties in MRI interpretation and treatment decisions. The aim of the study is to systematically investigate the pyramidalis muscle and its anatomical connections with adductor longus and rectus abdominis, to elucidate injury patterns occurring with adductor avulsions. METHODS: A layered dissection of the soft tissues of the anterior symphyseal area was performed on seven fresh-frozen male cadavers. The dimensions of the pyramidalis muscle were measured and anatomical connections with adductor longus, rectus abdominis and aponeuroses examined. RESULTS: The pyramidalis is the only abdominal muscle anterior to the pubic bone and was found bilaterally in all specimens. It arises from the pubic crest and anterior pubic ligament and attaches to the linea alba on the medial border. The proximal adductor longus attaches to the pubic crest and anterior pubic ligament. The anterior pubic ligament is also a fascial anchor point connecting the lower anterior abdominal aponeurosis and fascia lata. The rectus abdominis, however, is not attached to the adductor longus; its lateral tendon attaches to the cranial border of the pubis; and its slender internal tendon attaches inferiorly to the symphysis with fascia lata and gracilis. CONCLUSION: The study demonstrates a strong direct connection between the pyramidalis muscle and adductor longus tendon via the anterior pubic ligament, and it introduces the new anatomical concept of the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC). Knowledge of these anatomical relationships should be employed to aid in image interpretation and treatment planning with proximal adductor avulsions. In particular, MRI imaging should be employed for all proximal adductor longus avulsions to assess the integrity of the PLAC.

Premorbid obesity, but not nutrition, prevents critical illness-induced muscle wasting and weakness.

BACKGROUND: The 'obesity paradox' of critical illness refers to better survival with a higher body mass index. We hypothesized that fat mobilized from excess adipose tissue during critical illness provides energy more efficiently than exogenous macronutrients and could prevent lean tissue wasting. METHODS: In lean and premorbidly obese mice, the effect of 5 days of sepsis-induced critical illness on body weight and composition, muscle wasting, and weakness was assessed, each with fasting and parenteral feeding. Also, in lean and overweight/obese prolonged critically ill patients, markers of muscle wasting and weakness were compared. RESULTS: In mice, sepsis reduced body weight similarly in the lean and obese, but in the obese with more fat loss and less loss of muscle mass, better preservation of myofibre size and muscle force, and less loss of ectopic lipids, irrespective of administered feeding. These differences between lean and obese septic mice coincided with signs of more effective hepatic fatty acid and glycerol metabolism, and ketogenesis in the obese. Also in humans, better preservation of myofibre size and muscle strength was observed in overweight/obese compared with lean prolonged critically ill patients. CONCLUSIONS: During critical illness premorbid obesity, but not nutrition, optimized utilization of stored lipids and attenuated muscle wasting and weakness.

Compliance of the abdominal wall during laparoscopic insufflation.

BACKGROUND: To provide adequate workspace between the viscera and abdominal wall, insufflation with carbon dioxide is a common practice in laparoscopic surgeries. An insufflation pressure of 15 mmHg is considered to be safe in patients, but all insufflation pressures create perioperative and postoperative physiologic effects. As a composition of viscoelastic materials, the abdominal wall should distend in a predictable manner given the pressure of the pneumoperitoneum. The purpose of this study was to elucidate the relationship between degree of abdominal distention and the insufflation pressure, with the goal of determining factors which impact the compliance of the abdominal wall. METHODS: A prospective, IRB-approved study was conducted to video record the abdomens of patients undergoing insufflation prior to a laparoscopic surgery. Photo samples were taken every 5 s, and the strain of the patient's abdomen in the sagittal plane was determined, as well as the insufflator pressure (stress) at bedside. Patients were insufflated to 15 mmHg. The relationship between the stress and strain was determined in each sample, and compliance of the patient's abdominal wall was calculated. Subcutaneous fat thickness and rectus abdominus muscle thickness were obtained from computed tomography scans. Correlations between abdominal wall compliances and subcutaneous fat and muscle content were determined. RESULTS: Twenty-five patients were evaluated. An increased fat thickness in the abdominal wall had a direct exponential relationship with abdominal wall compliance (R 2 = 0.59, p < 0.05). There was no correlation between muscle and fat thickness. CONCLUSION: All insufflation pressures create perioperative and postoperative complications. The compliance of patients' abdominal body walls differs, and subcutaneous fat thickness has a direct exponential relationship with abdominal wall compliance. Thus, insufflation pressures can be better tailored per the patient. Future studies are needed to demonstrate the clinical impact of varying insufflation pressures.

Myosonographic study of abdominal wall dynamics to assess donor site morbidity after microsurgical breast reconstruction with a DIEP or an ms-2 TRAM flap.

BACKGROUND: Currently, autologous breast reconstruction with a free tissue transfer from the lower abdomen is considered to be a safe method that provides a stable long-term solution. The DIEP-flap and the ms-2-TRAM-flap reconstructions have helped reduce donor site morbidity. In order to assess the potential differences between these techniques, we carried out myosonographic evaluations that assessed the muscle dynamics pre- and post-operatively. In addition to investigating the properties of the rectus abdominis muscle post-operatively, this prospective study also allowed us to analyse the muscle preoperatively and to investigate the prospects for harvesting a DIEP-flap as opposed to a TRAM-flap. MATERIALS AND METHODS: Sixty patients underwent breast reconstruction with 71 (11 bilateral) free abdominal wall flaps (DIEP-: n = 48; ms-2-TRAM-flap: n = 23). Myosonographic examinations were performed preoperatively and at 3 and 6 months post-operatively. The thickness of the muscle at relaxation and maximum contraction and the difference between the muscle thickness measured at the two states were measured. A general-linear-model (GLM) was used for statistical analysis. The main variable was the surgical method, and the co-variables included BMI and patient age. The decision on whether to harvest a DIEP- or ms-2-TRAM-flap was made intra-operatively and based on the dominant perforator. RESULTS: It shows that the patients who underwent breast reconstruction with a DIEP-flap had significantly better muscle function (p < 0.05) in the follow-up. In addition, the analysis revealed that better muscle function before surgery made it more likely that a patient would undergo a DIEP-flap-reconstruction successfully. Patient age also had a highly significant effect on muscle recovery (p < 0.0005). CONCLUSIONS: This prospective study used a dynamic ultrasound evaluation of the abdominal wall and showed that the DIEP-flap significantly reduces donor site morbidity compared to the ms-2-TRAM-flap. The study also showed that good preoperative muscle function might increase the probability of surgeons performing a DIEP-flap reconstruction.

[The imaging study of internal mammary artery and its branches ].

OBJECTIVE: To investigate the distribution of the internal mammary artery and its branches by the multi-slice spiral CT angiography, and to explore the feasibility of transferring pedicled transverse rectus abdomials myocataneous (TRAM) flap for breast reconstruction through resection of inferior costicartilages. METHODS: 30 female patients received abdominal CT angiography. (1) The distance between internal mammary artery and the sternum midline were recorded; (2) The position and the numbers of branches from bilateral internal mammary arteries at the level of 5th, 6th, 7th rib was observed; (3) The points where the superior epigastric artery gets through the rectus abdominis muscle were located. RESULTS: ( The average distance between left internal mammary artery to the sternum midline is from 1. 66 cm (0. 62-2. 39 cm ) to 2.34 cm (0.69-3.36 cm) at the level from 4th to 6th intercostal space. The average distance between right internal mammary artery to the sternum midline is from 1.55 cm(0. 66-2. 29 cm) to 2.29 cm(0. 73-3. 67 cm) at the level from 4th to 6th intercostal space; ) The number of branches is the most at the level of 6th intercostal space; (3) There are 235 branches in the superior epigastric artery. CONCLUSIONS: This imaging study of internal mammary artery explores the feasibility of transferring pedicled transverse rectus abdominals myocataneous flap for breast reconstruction. It has important significance in the breast reconstruction using TRAM flap with lengthened pedicle.

Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis: comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively.

PURPOSE: To evaluate and compare the consistency of agreement of two methods for measuring abdominal rectus diastasis (ARD), preoperative computed tomography (CT) scanning and preoperative clinical assessment were compared with direct measurement intraoperatively. METHODS: Fifty-five consecutive patients were retrieved from an ongoing prospective randomised trial comparing two operative techniques for the repair of ARD. All patients underwent a preoperative clinical assessment and CT scan, and the results were compared with intraoperative measurement of the ARD width. Agreement between methods was described with Bland-Altman plots (BA plots) and calculated using Lin's Concordance Correlation Coefficient (CCC). RESULTS: The median width of the diastasis was 4.0 cm in the upper midline and 3.0 cm in the lower midline for the intraoperative measurement. BA plots showed that measurements on CT and intraoperatively are not in agreement in the lower midline, whereas the agreement was stronger between the clinical and the intraoperative method. The CCC was higher for clinical vs. intraoperative measurement (0.479) than for CT vs. intraoperative measurement (-0.002) in the lower midline, although the agreement was over all low. CT scanning underestimated the width of the ARD when compared to 87 % of preoperative clinical assessments, and 83 % of intraoperative measurements. Preoperative clinical assessment overestimated ARD in 35 % when compared with intraoperative measurements. CONCLUSION: Clinical assessment prior to surgery provides more accurate information than CT scanning in the assessment of ARD width. CT scanning underestimates ARD width when compared with intraoperative measurement.

Stoma siting and the 'arcuate line' of Douglas: might it be of relevance to later herniation?

AIM: Preoperative stoma site marking aims to select an appropriate location for stoma positioning but there are no fixed anatomical points of reference. A stoma raised below the arcuate line (AL) of the posterior rectus sheath may be a contributing factor to later herniation. METHOD: The patients' preferred position for a stoma was marked preoperatively by a nurse stomatherapist in 75 unselected cases. The position of the AL was determined in relation to standard anatomical landmarks (umbilicus, xiphoid process, pubic symphysis and the anterior superior iliac spines). RESULTS: The proportion of patients whose stoma trephine was sited below the AL varied with the anatomical landmark examined. Measurements of symphysis pubis to xiphoid process or height above the iliac spines revealed 36-41% of chosen sites were at or below the AL. In 16 of 29 (55%) women the marked sites were at or below the AL. Of 44 patients who had their site marked above the AL, 23 (53%) were within 2 cm of the AL. In obese patients and those with a waist circumference greater than 100 cm over 50% had their site marked at or within 2 cm of the AL. CONCLUSION: To ensure a stoma site is above the AL of the posterior rectus sheath its centre should be at least 4 cm above a horizontal line between the anterior superior iliac spines. This might reduce later herniation rates.

[Histological changes after the recontruction of tongue defect with rectus abdominis musculoperitoneal flap].

OBJECTIVE: To observe the cellular morphological and histological changes of the reconstructed tongue defect by rectus abdominis musculoperitoneal flap of dogs with or without nerve. METHODS: 12 Beagle dogs were randomly divided into two groups. Group A made rectus abdominis musculoperitoneal flap with the intercostal nerve while group B without the intercostal nerve. Nerve anastomosis was performed in Group A while not in Group B in the repairment. 12 weeks later, the length, width, surface area and cellular morphology and histological changes of the two transfer flaps were observed. RESULTS: The length, width, surface area of transplanted rectus abdominis musculoperitoneal flaps in group A were greater than those in Group B, and the differences were statistically significant at 12th week (P < 0.01). The microscope study found that the transplanted rectus abdominis musculoperitoneal flaps of group A had part of muscle fiber atrophy with some connective and adipose tissue, loose muscle fiber arrangement, while the transplanted rectus abdominis musculoperitoneal flaps of Group B had muscle cells atrophy with some adipocyte. The structure of muscle cells in Group A was basically normal, but it was disorder in Group B. The type II muscle fibers of Group B was atrophy and substituted by a lot of connective tissue. CONCLUSION: After tongue defect reconstructed by rectus abdominis musculoperitoneal flap with nerve, the changes of muscle fibers could be similar to tongue muscles, providing a basis for the dynamic recovery of the tongue.

Intramuscular perforator dissection with the hydrodissection technique.

BACKGROUND: Perforator flap breast reconstruction requires increased time for safe perforator dissection, especially the intramuscular course. We describe an adjunctive technique using hydrodissection to assist with the intramuscular perforator dissection. METHODS: Hydrodissection techniques were used for perforator dissection in 45 consecutive patients (64 flaps) undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. These patients were compared with 39 patients (55 flaps) immediately prior to the use of this technique. The study time frame was between March 2008 and March 2010. Patient demographics, complications, and operative times were collected through an extensive chart review. RESULTS: There were no major differences in complications between groups; there were no flap losses encountered during this series, and fat necrosis rates were similar (9.4% with hydrodissection and 14.5% without, p = 0.41). Total operative time for bilateral reconstructions decreased by 59 minutes (p = 0.13) and 21 minutes (p = 0.57) for unilateral reconstructions with the utilization of hydrodissection, though this was not statistically significant. CONCLUSIONS: The use of hydrodissection to assist with intramuscular perforator vessel dissection is safe to perform, as there was no increase in complications. The procedures utilizing hydrodissection were faster, and surgeons using this technique found it easier to visualize the perforators and dissect through the intramuscular course.

Clinical Implications caused by the agenesis of the RectusAbdominal Muscle’s (MRA) inferior venter

The rectus abdominal muscle is part of the anterior abdominal wall, having three to six bellies. In only oneof the 106 dissections already made in the “Faculdade de Ciências Médicas de Minas Gerais” AnatomyLaboratory was found a male cadaver who did not have inferior venter of this muscle bilaterally. Instead, at theleft side, was found a tendon that measured 5.5 cm laterally and 12 cm medially, and at the right side, therewas the same variation with a 15.5 cm length tendon, rising in the upper branch of the pubis and crest pubis.Despite being a rare variation, individuals who have showed it have increased potential for physiological andsurgical complications, in case they need interventions using inferior rectus abdominis muscle venter’s snips.

Comparisons of the postoperative rectus abdominis muscle thickness and the biomechanical properties of donor sites among different subtypes of muscle-sparing transverse rectus abdominis myocutaneous flaps (MS0, MS1, MS2, MS3): a rat model.

BACKGROUND: The primary presumed advantages of the deep inferior epigastric perforator flap over the other muscle-sparing (MS) transverse rectus abdominis myocutaneous flaps are the improved functional rectus abdominis muscle outcomes and decreased abdominal contour morbidities. The purpose of this study was to verify this viewpoint objectively and quantitatively using an animal model. METHODS: Six rats were used in the pilot study and 40 rats were equally divided into a control group and 4 experimental groups (MS0, MS1, MS2, and MS3) according to the amount of rectus abdominis muscles harvested. At 3 and 6 weeks, 4 rats in each group were killed, then, the percentage of residual rectus abdominis muscle thickness compared with the control side and the ultimate load at failure of the abdominal wall were recorded and compared. RESULTS: All of the flaps survived completely without complications. Regarding the percentage of residual rectus abdominis muscle thickness compared with the control side, the results suggested MS3 > MS2 ≈ MS1 > MS0; concerning the ultimate load at failure of the abdominal wall, the results showed MS3 ≈ MS2 > MS1 > MS0. (≈: P > 0.05; >: P < 0.05). CONCLUSIONS: According to the findings of this study, we advocate the use of the deep inferior epigastric perforator flap when possible, and the MS2-transverse rectus abdominis myocutaneous flap can serve as a backup when the perforator anatomy does not meet the flap safety criteria for preservation of rectus abdominis muscle function.

Dominance between angiosome and perforator territories: a new anatomical model for the design of perforator flaps.

An understanding of the angiosome of a source vessel in supply to a perforator flap is essential to flap design. With substantial interindividual variability in the size and reliability of such territories, preoperative awareness of factors that affect the number or size of perforators in a given territory can aid operative planning. Body weight and scarring are known to modify a given territory, and anecdotally so too can the "dominance" of adjacent vascular territories. A clinical study of 300 patients (600 body sides) was undertaken, using computed tomographic angiography, to map the vessels of six vascular territories. The effect of interplay between vascular territories was assessed by establishing whether a dominant territory was associated with a diminutive adjacent territory. For every vascular territory investigated, the effect of "dominance" was evident, with a statistically significant effect shown between the deep inferior epigastric artery and superficial inferior epigastric artery territories (p < 0.01), and the anteromedial thigh and anterolateral thigh perforator territories (p = 0.01). The size or dominance of perforators in a given vascular territory is influenced by the dominance of adjacent vascular territories. This concept of perforator or angiosome dominance is an important factor in the design of perforator flaps.

Variations in the pattern of formation of the abdominis rectus muscle sheath among Kenyans / Variaciones en el patrón de formación de la vaina del músculo recto abdominal en kenianos

The pattern of formation of the human rectus sheath exhibits variations, it is not clear if these variations are population specific. This study aimed at describing the pattern of formation of the rectus sheath in a select Kenyan population. Formation of the rectus sheath was analyzed in eighty subjects (47 male, 33 female) during autopsies and cadaveric dissection. The anterior wall of the rectus sheath in all cases was aponeurotic and firmly attached to rectus abdominis muscle. The posterior wall of the rectus sheath was aponeurotic in 71 (88.5 percent) cases, the rest were musculoaponeurotic and only seen in males. In all cases the aponeurosis of internal oblique abdominis split into two lamina; a deep lamina that fused with the aponeurosis of transverses abdominis at the lateral border of rectus abdominis and a superficial lamina that fused with aponeurosis of external oblique abdominis mid-way between the medial and lateral borders of rectus abdominis muscle. The pattern of formation of the rectus sheath among Kenyans shows some variations which have not been reported by previous workers. Knowledge of these variations is important in surgery as this sheath is always incised when making most aabdominal incisions.

El patrón de formación de la vaina del músculo recto abdominal humano muestra variaciones, no está claro si estas variaciones son población-específicas. Este estudio tiene como objetivo describir el patrón de formación de la vaina del músculo recto del abdomen en una población seleccionada de Kenia. La formación de la vaina del músculo recto del abdomen se analizó en 80 sujetos (47 hombres, 33 mujeres) durante autopsias y disección de cadáveres. La pared anterior de la vaina del músculo recto en todos los casos era aponeurótica y firmemente unida al músculo recto abdominal. La pared posterior de la vaina del músculo recto era aponeurótica en 71 (88,5 por ciento) casos, las paredes restantes eran musculoaponeuróticas y sólo se observaron en varones. En todos los casos, la aponeurosis del músculo oblicuo interno del abdomen se dividió en dos láminas, una lámina profunda que se fusionaba con la aponeurosis del músculo transverso del abdomen en el borde lateral del músculo recto del abdomen y una lámina superficial que se fusionaba con la aponeurosis del músculo oblicuo externo del abdomen a mitad del recorrido entre los bordes medial y lateral del músculo recto del abdomen. El patrón de formación de la vaina del músculo recto del abdomen, entre los kenianos muestra algunas variaciones que no han sido reportadas en trabajos anteriores. El conocimiento de estas variaciones es importante en cirugía ya que esta vaina es seccionada en abordajes abdominales.

Surgical correction of a buried penis focusing on the mons as an anatomic unit.

A 54-year-old man with a severely concealed penis secondary to progressive obesity is presented. Circumferential adhesion release of the penis and monsplasty using bilateral elliptical excisions and suction-assisted lipectomy were carried out to restore shaft length. Specifically addressing the mons as an anatomic unit requiring defatting for adequate penile projection, as is described in this case report, has not been previously reported in the literature.

Effect of Swimming Training on the Rectus Abdominis Muscle of rats: Morphological and Histochemical Aspects / Efecto de la Natación Sobre el Músculo Recto del Abdomen de la Rata: Aspectos Morfológicos e Histoquímicos

We investigated the effect of swimming training in rats on morphological characteristics, hypertrophy levels and metabolic and contractile adaptations of different fiber types in rat the rectus abdominis muscle. Rats were randoverly assigned to one of three groups (N = 5 each): a) swimming training for 1 h, twice a week (2x/w), b) 1 h five times a week (5x/w) for 9 consecutive weeks, or c) without any swimming training (Control). Body weight increased in 2x/w rats and decreased in the 5x/w ones. Muscle fiber diameters increased in both trained groups, with higher values in the 2x/w group. Aerobic exercise increased slow oxidative (SO) + fast-oxidative-glycolytic (FOG) fibers and decreased fast glycolytic (FG) fibers. In addition, SO fibers were increased and FOG + FG fibers were decreased in trained rats. Small and angulated atrophic fibers were also observed. These results corroborate that swimming exercise increases aerobic metabolism and thus oxidative and low contraction fibers. However, the used protocol induced, to a variable degree, changes in the muscle fiber morphology.

Se estudió el efecto de la natación en las características morfológicas, niveles de hipertrofia y las adaptaciones metabólicas y contráctiles de diferentes tipos de fibras en el músculo recto del abdomen de ratas. Las ratas fueron asignadas en tres grupos (N = 5 cada uno): a) natación por 1 hora dos veces a la semana (2x/s), b) 1 hora, cinco veces por semana (5x/s) por nueve semanas consecutivas y c) sin natación (control). El peso corporal se incrementó en las ratas 2x/s y disminuyó en 5x/s. El diámetro de las fibras musculares aumentó en ambos grupos entrenados, con mayores valores en las ratas 2x/s. El ejercicio aeróbico incrementó las fibras de oxidación lenta (OL) + las fibras de glicólisis oxidativa rápida (GOR) y disminuyeron las fibras de glicólisis rápida (GR). Además, las fibras OL aumentaron y las fibras GOR y GR disminuyeron en las ratas entrenadas. Se observó una pequeña atrofia y deshidratación de las fibras. Estos resultados corroboran que la práctica de la natación incrementa el metabolismo aeróbico, las fibras de contracción lenta y la oxidación. Sin embargo, el protocolo utilizado induce cambios en grado variable en la morfología de las fibras musculares.