Anatomical study and clinical importance of the inferior epigastric artery / Estudio anatómico e importancia clínica de la arteria epigástrica inferior

SUMMARY: The inferior epigastric artery (IEA) is a major blood vessel that supplies the anterior abdominal wall. The aim of the current study was to provide clinicians, surgeons, and obstetricians with sufficient anatomical data on the inferior epigastric artery, such as its origin and branching pattern. The study included 20 embalmed cadavers, these cadavers were dissected, and the inferior epigastric artery and vena comitans/venae comitantes were identified and traced downwards to the external iliac vessels. The origins, caliber, course and pedicle length of both the artery and the vein(s) were studied. The inferior epigastric artery arose independently from the distal external iliac artery deep to the inguinal ligament in 19 (95 %) cadavers. The artery entered the rectus abdominis muscle at its middle third in 13 (65 %) cases and at its lower third in the remaining specimens. In this study, we found that the artery divided into two branches in 18 (90 %) of the cases; in the remaining two cases, it continued as one trunk. The average pedicle length was 7.2 cm. The mean caliber of the IEA was 3.7 mm. In 18 (90 %) dissections, the venous drainage consisted of a pair of venae comitantes that united to form a common vessel at their draining point on the external iliac vein. The average diameter was 3.9 mm. The current study focuses on the anatomical features of the inferior epigastric artery to increase the success rate of abdominal and pelvic operations in clinical practice.

RESUMEN: La arteria epigástrica inferior (AEI) es un vaso sanguíneo principal que irriga la pared abdominal anterior. El objetivo del presente estudio fue proporcionar a los médicos, cirujanos y obstetras suficientes datos anatómicos sobre la arteria epigástrica inferior, como su origen y patrón de ramificación. El estudio incluyó 20 cadáveres embalsamados, los que se disecaron y se identificó la arteria epigástrica inferior y la vena concomitante y se siguieron hasta los vasos ilíacos externos. Se estudiaron los orígenes, calibre, trayecto y longitud del pedículo tanto de la arteria como de la (s) vena (s). La arteria epigástrica inferior surgió independientemente de la arteria ilíaca externa profunda al ligamento inguinal en 19 (95 %) cadáveres. La arteria ingresó al músculo recto del abdomen en su tercio medio en 13 (65 %) casos y en su tercio inferior en las muestras restantes. En este estudio, encontramos que la arteria se dividió en dos ramas en 18 (90 %) de los casos; en los dos casos restantes, continuó como un tronco. La longitud media del pedículo fue de 7,2 cm. El calibre medio del AEI fue de 3,7 mm. En 18 (90 %) disecciones, el drenaje venoso consistió en un par de venas concomitantes las que formaron un vaso común en su punto de drenaje en la vena ilíaca externa. El diámetro medio fue de 3,9 mm. El estudio actual se centra en las características anatómicas de la arteria epigástrica inferior con el propósito de mejorar la tasa de éxito de las cirugías abdominales y pélvicas en la práctica clínica.

Effect of closure of anterior abdominal wall layers on early postoperative findings at cesarean section: A prospective cross-sectional study

Abstract Objective To investigate the effect of closure types of the anterior abdominal wall layers in cesarean section (CS) surgery on early postoperative findings. Methods The present study was designed as a prospective cross-sectional study and was conducted at a university hospital between October 2018 and February 2019. A total of 180 patients who underwent CS for various reasons were enrolled in the study. Each patient was randomly assigned to one of three groups: Both parietal peritoneum and rectus abdominis muscle left open (group 1), parietal peritoneum closure only (group 2), and closure of the parietal peritoneum and reapproximation of rectus muscle (group 3). All patients were compared in terms of postoperative pain scores (while lying down and duringmobilization), analgesia requirement, and return of bowel motility. Results The postoperative pain scores were similar at the 2nd, 6th, 12th, and 18th hours while lying down. During mobilization, the postoperative pain scores at 6 and 12 hours were significantly higher in group 2 than in group 3. Diclofenac use was significantly higher in patients in group 1 than in those in group 2. Meperidine requirements were similar among the groups. There was no difference between the groups' first flatus and stool passage times. Conclusion In the group with only parietal peritoneum closure, the pain scores at the 6th and 12th hours were higher. Rectus abdominismuscle reapproximations were found not to increase the pain score. The closure of the anterior abdominal wall had no effect on the return of bowel motility.

Diseases and Findings of the Shigyakusan Effective Cases in Our Institution / 日本東洋医学雑誌

We retrospectively surveyed and analyzed medical records of 41 effective cases with shigyakusan including shigyakusan decoction and shigyakusan extract. In classics, fullness in chest and hypochondrium and rectus abdominis muscle stiffness along with coldness of the extremities is regarded as important clinical indication of shigyakusan. In this analysis, patients who present fullness in chest and hypochondrium are more than 90%, and patients presenting rectus abdominis muscle stiffness are more than 60%, confirming that these findings are important. On the other hand, although more than half of the patients feel excessive sensitivity to cold, only about 20% of the patients had coldness of the extremities as objective Kampo findings in their medical records. Until now, coldness of the extremities has been considered to be important because shigyaku means Japanese expression of it. But our obtained results show that shigyakusan is used for the patients who do not have cold extremities.

Application of pedicled transverse rectus abdominis muscle flap in breast reconstruction surgery / 中国癌症杂志

With the improving of people's living quality and medical technology, the demand for breast reconstruction after mastectomy is increasing. Transverse rectus abdominis muscle (TRAM) surgery is an important way of autologous tissue breast reconstruction. This article introduced the anatomy and blood supply of TRAM flap, the indications and contraindications of TRAM surgery, procedure and complications of the surgery. This article also discussed some problems in surgery. TRAM reconstruction, as a way of autologous tissue reconstruction, can avoid the implant related complications because the implant is not used in the surgery. In addition, compared to the implant recon-struction, the appearance and softness of autologous tissue reconstruction are closer to natural breasts, and the result of this surgery is better. In the meantime, pedicled TRAM reconstruction, which does not need microvascular anastomosis technique and close postoperative monitoring of the flap, is easy to be mastered by surgeons and could be performed at more medical centers. Therefore, the TRAM flap still has its own application prospect.

Rectus Abdominis Muscle Tuberculosis Involving Lung and Endometrium / 이화의대지

Extrapulmonary tuberculosis usually involves the pleura, central nervous system, lymphatic system, genitourinary system and bone with joint. There are few reports about pulmonary tuberculosis involving the endometrium and muscle. A 32-year-old woman who had intact immunity visited hospital due to menorrhagia, and was diagnosed with endometrial tuberculosis. The patient also had a painless abdominal mass about for 1 year before she came to the hospital. She was diagnosed with rectus abdominis muscle tuberculosis, endometrial tuberculosis, and pulmonary tuberculosis at the same time. We report a case of endometrial tuberculosis accompanied with rectus abdominis muscle and pulmonary tuberculosis in a non-immunosuppressed person.

Reconstrução mamária com TRAM: uma técnica alternativa para o fechamento do defeito abdominal / Breast Reconstruction with the transverse rectus abdominis flap: an alternative technique for the closure of abdominal defects

INTRODUÇÃO: O retalho do músculo reto abdominal, descrito por Drever em 1977, foi posteriormente modificado e, desde então, se tornou rapidamente uma importante alternativa para reconstrução da mama. Dentre as complicações do TRAM, citam-se os abaulamentos e hérnias abdominais na área doadora. Este estudo vem propor uma técnica alternativa de reparo do defeito abdominal, com o objetivo de minimizar tais inconvenientes e proporcionar melhores resultados. MÉTODO: O estudo é de caráter retrospectivo, totalizando 120 mulheres submetidas à reconstrução mamária com TRAM com colocação de tela abdominal, e seguimento mínimo de seis meses, entre Maio de 2003 e Novembro de 2012. As pacientes foram divididas em dois grupos: Grupo 1 (53 casos) reconstruídos com tela de polipropileno posicionada entre os folhetos aponeuróticos dos músculos oblíquo externo e interno, e Grupo 2 (67 casos) realizado fechamento da linha arqueada de Douglas e o remanescente inferior da aponeurose do músculo reto abdominal e reforço com tela. RESULTADOS: As pacientes foram avaliadas pelo mesmo cirurgião, obedecendo aos mesmos critérios. Os resultados obtidos foram 18,9% de abaulamentos no grupo 1 e 3% no grupo 2, estatisticamente significativo. Abaulamentos e hérnias no hipogástrio variam de 20% a 44% e 12,5% a 20% respectivamente, quando fechados primariamente. Quando associado a aplicações de telas sintéticas, esses percentuais diminuem para 1,5% a 6%. O aprimoramento técnico e a comparação de resultados têm a finalidade de minimizar tais complicações. CONCLUSÃO: A técnica descrita mostra-se vantajosa, pois permitiu significativa diminuição da complicação mais comum, permitindo satisfação estética e funcional das pacientes.

INTRODUCTION: The transverse rectus abdominis muscle (TRAM) flap, described by Drever in 1977, was subsequently modified and since then, has rapidly become an important alternative for breast reconstructions. However, bulges and abdominal hernias in the donor area are some of the complications arising from the TRAM flap. This study proposes an alternative technique for the repair of the abdominal defect that minimizes complications and provides better results. METHOD: The retrospective included 120 women who underwent breast reconstruction with TRAM with placement of an abdominal mesh between May 2003 and November 2012, with follow-up of at least six months. Patients were divided into two groups: Group 1 (53 cases) underwent reconstruction with polypropylene mesh positioned between the aponeurotic layers of the external and internal oblique muscles and Group 2 (67 cases) underwent closure of the arcuate Douglas' line and the remaining lower aponeurosis of the rectus abdominis muscle and reinforcement with mesh. RESULTS: The patients were evaluated by the same surgeon, according to the same criteria. The rate of bulging was 18.9% in group 1 and 3% in group 2, a statistically significant difference. Bulges and hernias in the hypogastrium varied from 20% to 44% and 12.5% to 20% respectively, when closed primarily. When synthetic mesh was used, these percentages decreased to 1.5% to 6%. The technical improvement and comparison of results aims to minimize such complications. CONCLUSION: The technique described is advantageous in that, it significantly reduced the occurrence of the most common complication, and increased the aesthetic and functional satisfaction of the patients.

Synchronous Development of Schwannoma in the Rectus Abdominis and Lipoma in the Chest: A Case Report / 대한골관절종양학회지

We experienced a case of 63 years old male patient who had synchronous rectus abdominis intramuscular schwannoma and chest wall lipoma. Schwannoma is rare benign tumor which derived from nerve sheath and mainly peripheral nerve of flexor part. The authors report rare synchronous schwannoma and lipoma development.

Free Flap Transplantation in Open Tibial Fracture with Vessel Injury in the Elderly

Two aged patients who had open tibial fractures with arterial injury caused by high energy accidents underwent emergency arterial reconstruction using a greater saphenous vein and soft tissue repair using free flaps. In the patients, soft tissue necrosis developed and tibias were exposed at postoperative third week. Follow-up angiography through the superficial femoral artery showed occlusion of the anterior tibial artery. The anterior tibial artery was reconstructed using the contralateral greater saphenous vein graft and the latissimus dorsi myocutaneous and rectus abdominis muscle free flaps were transplanted for repair of necrotic soft tissue. The reconstructed arteries showed good perfusion to the new free flaps until union of the tibias occurred. The patients were followed-up for 21 years and 17 years postoperatively, respectively. In management of open comminuted fracture of the tibia, injury of the arterial system must be ruled out by angiography in addition to evaluation of the degree of soft tissue injury.

Anatomical Review of Rectus Abdominis Muscle Free Flap for the Oral and Maxillofacial Reconstruction

Hematoma espontâneo de parede abdominal: relato de caso e revisão de literatura / Spontaneous abdominal wall hematoma: case report and literature review

O hematoma espontâneo da parede abdominal é uma entidade infrequente que corresponde ao acúmulo de sangue na bainha do reto abdominal. Relata-se o caso de uma paciente admitida com insuficiência cardíaca crônica, hipertensão arterial sistêmica, fibrilação atrial crônica e insuficiência renal crônica que, embora com coagulograma normal, desenvolveu um sangramento espontâneo da parede abdominal. O tratamento adotado foi o conservador, com sucesso. Segue-se uma revisão da literatura sobre o assunto e uma discussão sobre a conduta mais apropriada.

The spontaneous abdominal wall hematoma is an infrequent entity which corresponds to the accumulation of blood in the sheath of the rectus abdominis muscle. We report a case of a patient admitted with chronic heart failure, hypertension, chronic atria fibrillation and chronic renal failure that, although with normal coagulation tests results, developed a spontaneous bleeding in the abdominal wall. Conservative treatment was adopted with success. A review of the literature about the subject and a discussion about the more appropriated approach are followed.

Study of the Inferior Epigastric Artery Using Anatomical and Radiologic Method for Flap Surgery / 대한해부학회지

The knowledge of arterial patterns of donor and recipient sites is very important for performing a flap surgery. In order to perform a flap surgery using the rectus abdominis muscle knowledge of the distributions, tributaries, and anastomoses of the inferior epigastric artery is necessary. The aim of this study was to establish the clinical and anatomical characteristics of the inferior epigastric artery for flap surgery in Koreans. Sixteen fresh cadavers were injected bilaterally with a radiopaque dye solution through the brachial and popliteal arteries, radiographic images were obtained after the anterior abdominal wall was removed surgically. Subsequently, the anterior abdominal walls of the cadavers were dissected and measured by using metric and non-metric methods. In a majority of the cadavers (83.9%), the inferior epigastric artery had only one main stem. Between the umbilicus and the xiphoid process, the most common type of the anastomosis was multiple anastomoses (Type IV, in 32.1% of the cases), followed by no anastomosis (Type I) and single anastomosis (Type II) in 25% of the cases, respectively. The intramuscular branch of the inferior epigastric artery originated from below the umbilicus in 60.7% of the cases and above it in 39.3% of the cases. The peritoneal branch was further divided into 3 types: lateral, medial, and umbilical. One of them coexisted with other branch of specimen. The peritoneal branch commonly originated from the intramuscu-lar branch. The perforating branch, with an external diameter of greater than 0.5 mm, was clinically significant, was dis-tributed around the umbilicus. The number of arterial branches directly perforating the rectus abdominis muscle was greater than that of those traveling anteriorly. The results of this study may enhance the anatomical knowledge of clinicians with respect to flap surgery or surgical treatments involving the anterior abdominal wall.

Endocervicosis presenting as abdominal wall mass / 대한산부인과학회지

Endocervicosis refers to the presence of benign mucinous glands of endocervical type in ectopic site. It is rare and usually detected incidentally by histologic examination. The urinary bladder is the most common site, but peritoneum, small bowel, abdominal scar, outer wall of the cervix, vagina, and lymph nodes have been documented. Because this is the first documented report of endocervicosis arising in the rectus muscle in korea, we report this with a brief review of the concerned literatures.

Morphometry and Histochemistry of the Rectus abdominis Muscle Fibers of Tufted Capuchin Monkeys (Cebus apella Linnaeus, 1758) / Morfometría e Histoquímica de las Fibras del Músculo Recto del Abdomen del Mono Capuchino Almohadillado (Cebus apella Linnaeus, 1758)

The phylogenetic proximity of primates to humans, along with their behavioral, biochemical, and anatomical similarities, make such animals more interesting experimental models for biomedical researches, as compared to classical laboratory animals. Another aspect that has called the attention of researchers is the differentiated quadrupedalism present in some primates. The tufted capuchin monkey uses the ground and tree branches as its support for locomotion, showing various postures while performing this task. On the basis of this information, we have decided to study the rectus abdominis muscle of the tufted capuchin monkey, with the following goals: the frequency and area of fiber types; its possible compartmentalization; and identify if this muscle is better adapted to phasic or postural activities. To do this, samples were removed from 4 regions of the rectus abdominis muscle of 6 adult male tufted capuchin monkeys, and were submitted to reaction with m-ATPase, (with alkaline and acid pre-incubation), NADH, and H.E.. Results showed: a statistically significant difference (P<0.05) for both frequency and area, between fiber types FG and FOG and FG and SO, but did not show a statistically significant difference between fibers FOG and SO, in all studied regions; similarity in frequency and area of a same fiber type (FG, FOG, and SO) among the studied regions. Based on these data, it was concluded that: the rectus abdominis muscle of the tufted capuchin monkey does not show fiber compartmentalization, since the distribution and size patterns of the different fiber types are similar in the studied regions; there is a predominance of fast twitch fibers (FG + FOG) over slow twitch fibers (SO), for frequency and area, which characterizes the muscle as being more dedicated to phasic than to postural activities.

La proximidad filogenética y las semejanzas de comportamiento, bioquímicos y anatómicos, de los primates con los humanos convierten a estos animales en modelos experimentales más interesantes para las investigaciones biomédicas, que los animales clásicos de laboratorio. Otro aspecto que ha llamado la atención de los investigadores es el movimiento cuádruple diferente que presentan algunos primates. El macado clavo se traslada usando como apoyo el suelo y las ramas de los árboles, presentando posturas variadas en la ejecución de esas tareas. En base a estas informaciones se resolvió estudiar el músculo recto del abdomen del macaco-clavo, con los siguientes objetivos: observar la frecuencia y el área de los tipos de fibras de este músculo; observar posibles diferencias entre e1las y sus regiones media proximal y distal; y su participación en la locomoción de este animal. Para ello, fueron retiradas 4 muestras de 4 regiones del músculo recto del abdomen, de 6 macacos-clavos machos adultos, que fueron sometidos a las reacciones de m-ATPasa (previa incubaciones alcalina y ácida), NADH y HE. Los resultados mostraron: diferencias estadísticamente significativas (p<0,05) tanto en la frecuencia como en el área, entre las fibras del tipo FG y FOG y FG y SO, pero no presentaron diferencias estadísticamente significativas entre las fibras FOG y SO, en todas las regiones estudiadas. Basándome en estos datos, se concluye que el músculo recto del abdomen del macaco-clavo no presenta división de sus fibras, pues los patrones de distribución y tamaño de los diferentes tipo de de fibras son semejantes en las regiones estudiadas con predominio de las fibras de contracción rápida (FG + FOG) sobre aquellas de contracción lenta (SO), tanto en la frecuencia como en el área, caracterizándolo como un músculo más adaptado para las actividades sutiles que posturales.

Femoral Nerve Injury after Rectus Abdominis Muscle Slap Harvesting : A Case Report

PURPOSE: The Rectus abdominis muscle free flap is utilized in various reconstruction surgeries due to easiness in harvesting, consistency of vascular pedicle and reduced donor site morbidity. But rarely, femoral nerve injury during rectus abdominis harvesting can be resulted. We report a case of femoral nerve injury after rectus muscle harvesting and discuss the injury mechanism with the follow-up process of this injury. METHODS: To reconstruct the defect of middle cranial base after wide excision of cystic adenocarcinoma of the external ear, rectus muscle free flap was havested in usual manner. To achieve a long vessel, inferior epigastric artery was dissected to the dividing portion of femoral artery and cut. RESULTS: One week after the surgery, the patient noted sensory decrease in the lower leg, weakness in muscle strength, and disabilities in extension of the knee joint resulting in immobilization. EMG and NCV results showed no response on stimulation of the femoral nerve of the left leg, due to the defects in femoral nerve superior to the inguinal ligament. With routine neurologic evaluations and physical therapy, on the 75th day after the operation, the patient showed improvement in pain, sensation and muscle strength, and was able to move with walking frame. In 6 months after the operation, recovery of the muscle strength of the knee joint was observed with normal flexion and extension movements. CONCLUSION: Rarely, during dissection of the inferior epigastric artery, injuries to the femoral nerve can be resulted, probably due to excessive traction or pressure from the blade of the traction device. Therefore, femoral nerve injury can be prevented by avoiding excessive traction during surgery.

Motor Unit Action Potentials of the Rectus Abdominis Muscle according to Changes of Abdominal Pressure

OBJECTIVE: In current urodynamic studies, rectal catheters can cause erroneous result affecting detrusor pressure, and the catheter itself is not comfortable to the patients. To reduce these problems we investigated the relationship between the motor unit action potentials (MUAP) of rectus abdominis muscle and the abdominal pressure measured by rectal catheter. METHOD: Healthy seven men and three women volunteers (mean age: 49 years) with no neurological abnormality were enrolled. Possible maximal abdominal pressure (Pmax) was attained by Valsalva maneuver for 5 seconds. The MUAPs of the rectus abdominis muscle were recorded with surface electrodes for analysis. These recordings were done on 100, 80, 60, 40, and 20% of Pmax. The parameters of MUAP such as mean frequency, median frequency, turns, mean amplitude, and RMS (root mean square) were measured. RESULTS: Turns, mean amplitude, and RMS were increased in a proportion to the increment of abdominal pressure in all subjects(R=0.840, 0.879, and 0.984, respectively). CONCLUSION: These findings suggested that the surface MUAP of rectus abdominis muscle might be used indirectly for more convenient measurement of the abdominal pressure.

Reconstruction of the Cone-shaped Defect in the Temporal Area with Rectus Abdominis Free Flap

Defect on the temporal area caused by, surgical ablation of a tumor or an infection should be reconstructed immediately to prevent potentially life-threatening complications such as meningitis and cerebrospinal fluid leakage. The defect on the temporal area usually presents as a typical 'cone-shape'. Successful reconstruction requires sufficient volume of well-vascularized soft tissue to cover the exposed bone and dura. From 1994 through 2003, the authors applied rectus abdominis free flap for the reconstruction of the temporal defect from 1994 through 2003. There were 10 patients with a mean age of 52.1 years. Of these 10 patients, external auditory canal cancer was present in four patients, temporal bone cancer in two, parotid gland cancer in one and three patients were reconstructed after debridement of infection(destructive chronic otitis media). All the free flaps survived, and flap-related complications did not occur. Compared to a local flap, the rectus abdominis free flap can provide sufficient volume of well-vascularized tissue to cover the large defect and can be well-tolerated during an adjuvant radiation therapy. The long and flat muscle can be easily molded to fit in to the 'cone-shape' temporal defect without dead space. It is also preferred because of the low donor site morbidity, a large skin island and an excellent vascular pedicle. Two-team approach without position change is possible. In conclusion, the authors think that rectus abdominis free flap should be considered as one of the most useful method for the reconstruction of a cone-shaped temporal defect.

Cadaver as an experimental model to study abdominal wall tension

The use of cadaver as an experimental model to evaluate tension of the abdominal wall after aponeurotic incisions and muscular undermining is described on this article. The tension required to pull the anterior and the posterior rectus sheaths towards the midline was studied in fresh cadavers at two levels: 3 cm above and 2 cm below the umbilicus. Traction measurement was assessed with a dynamometer attached to suture loops on the anterior and posterior recti sheaths, close to the midline, above and below the umbilicus. The quotient of the force used to mobilize the aponeurotic site to the midline and its resulting displacement was called the traction index. These indices were compared in three situations: 1) prior to any aponeurotic undermining; 2) after the incision of the anterior rectus sheath and the undermining of the rectus muscle from its posterior sheath; and 3) after additionally releasing and undermining of the external oblique muscle. The experimental model described showed to be feasible to demonstrate the effects on tension of the abdominal wall after incisions and undermining of its muscles and aponeurosis.

O uso de cadáver como modelo experimental para a avaliação da tensão da parede abdominal após incisões aponeuróticas e descolamentos musculares é descrito neste artigo. A tensão necessária para levar a aponeurose anterior e posterior do músculo reto até a linha média foi estudada em cadáveres frescos em dois níveis: 3 cm superior e 2 cm inferiormente à cicatriz umbilical. As medidas de tração foram realizadas com o uso de um dinamômetro aclopado às alças realizadas com fio de sutura na aponeurose anterior e posterior dos retos, próximas à linha média, nos níveis supra e infra-umbilicais. A tração utilizada para mobilizar os pontos aponeuróticos até a linha média e seu deslocamento resultante foram denominados coeficiente de tração. Estes índices foram comparados em três situações: 1) anteriormente a qualquer descolamento; 2) após a incisão da aponeurose anterior do reto e o descolamento do músculo reto de sua aponeurose posterior; e 3) após, além da manobra anterior, a liberação e descolamento do músculo oblíquo externo. O modelo experimental descrito mostrou-se factível na avaliação da alteração da tensão na parede abdominal após incisões e descolamentos destes músculos e aponeuroses.

Morphologic Study of the Rectus Abdominis Muscle for Flap Surgery / 체질인류학회지

Forty-nine cadaver dissections (male 30, female 19) were performed to identify the shape and size of rectus abdominis muscle and the distribution of vessels in Korean for flap surgery. The total length between xiphoid process and pubic symphysis of male is 375.9+/-41.8 mm and female is 339.4+/-39.1 mm. But the length between umbilicus and pubic symphysis of male and female did not show significant difference. The three tendinous intersections are 61.2%, the 4 intersections are 35.7%, and 2 intersections are 3.1%. The most of first, second and third intersections had the most complete intersection. The most of fourth intersection had the most fragmentary intersection. The external diameter of superior epigastric artery is 1.4+/-0.3 mm, and inferior epigastric artery is 2.6+/-0.6 mm. The percentage of superior epigastric artery that goes into the medial 1/3 region of rectus abdominis muscle is 52%, middle 1/3 region is 38%, lateral 1/3 region is 2% and 2 stem goes into the muscle is 8%. The length between the origin of inferior epigastric artery and the point of semilunar line met inferior epigastric artery is 41.1 mm in male and 38.8 mm in female.

The Rectus Abdominis Flap for Reconstruction of Pressure Sores in Quadriplegia Patient

A pressure sore, such as quadriplegia, is developed in patients who have been idle in bed for a long time, particularly in the spinal cord. The treatment is particularly difficult in cases of multiple recurrent sores, osteomyelitis with pathologic fractures, other underlying conditions such as diabetes mellitus, immuno-suppression, or radiotherapy. Over the last 20 years, the development and popularization of rectus abdominis flap have significantly increased for reconstruction of a wide variety of difficult clinical problems. From March 2000 to Dec 2001, 6 neurologically impaired patients underwent reconstruction of chronic pressure sores utilizing an inferiorly based rectus abdominis musculocutaneous flap. Postoperative follow-up ranged from 6 to 15 months. The average thickness of rectus abdominis muscle in quadriplegic patient is less than half of that in healthy patient. In most cases, mild venous congestions are developed, but these were resolved by medical treatment. All wounds have healed without any significant complications such as flap loss, infection, hernia, and sepsis. In conclusion, rectus abdominis muscle for these reconstructions provides a simple, reliable solution to often difficult reconstructive problem. We recommended this highly viable, versatile and reliable flap as one to be considered in planning the reconstruction of the quadriplegia patient with pressure sores when other local and regional flaps are unavailable.

The Sternal Turn Over Procedure with Preservation of the Internal Mammary Vessel and Rectus Abdominis Muscle Pedicles for the Repair of Severe Pectus Excavatum.

Pectus excavatum or funnel chest is one of the most common congenital chest wall deformities. Surgical correction should be considered for all patients with moderate to severe deformities because of the significant cosmetic and psychological improvement, subjective increase in exercise tolerance, documented changes in the cardiac and respiratory status, and prevention of the development of scoliosis after surgical intervention in these patients. The sternal turn over procedure with preserved internal mammary vessels and rectus abdominis muscle pedicles for the corrective repair of severe pectus excavatum, involves resection of the deformed thoracic wall, sternum and ribs, preserving an attachment of the rectus abdominis muscle,and a vascular pedicle of the internal mammary vessel. A short segment resection above the ipsilateralcostal cartilage is mandatory to allow reposition of the vascular pedicle onto the presternal surface after turn over of the sternum. Multiple corrective osteotomy and costoplasty must be completed before refixing the sternum and ribs. The modified sternal turn over procedure restores the sternal blood supply and should be applied to the severe form of pectus excavatum which needs extensive and multiple bony resection. The procedure has been applied to a boy and a girl aged 5 years. At a three year follow up, the results obtained are excellent.