Abdominal wall function after rectus abdominis transfer.

The abdominal wall function of 57 patients who have undergone TRAM flap breast reconstructions using the whole rectus muscle, on one side (33 patients) or both (24 patients), was evaluated 6 months to 2 years after surgery. The defect was repaired with a Teflon mesh buried in the rectus sheath. There was a perfect tolerance to the mesh, and no hernia or bulging of the abdominal wall developed. Patients had less back pain after (10 patients) than before (18 patients) the operation and found their sit-up and sport possibilities about the same as before. Detailed assessment of the abdominal muscles by the physiotherapist showed, however, a decreased function, more evident in bilateral cases. CT scans demonstrated a medialization of the lateral muscles, leaving only a small medial portion of the abdominal wall devoid of muscles. On the whole, no problem of clinical significance was encountered, and patients showed a high degree of satisfaction with the operation.     

The segmental rectus abdominis free flap for ankle and foot reconstruction.

The reconstruction of soft-tissue defects of the ankle and foot usually requires free-tissue transfer. Although certain local flaps have been described for the reconstruction of these injuries, their utility may be compromised by significant crush injury or the size and location of the defect. Part of the rectus abdominis muscle, the segmental rectus abdominis free flap, is ideally suited for this use because of the muscle's versatility, reliability, and negligible donor deformity when harvested through a low transverse abdominal incision. Seven patients reconstructed with this flap are presented, and the technique is discussed. All patients have been successfully reconstructed with preservation of the ankle and foot. At present, all patients are fully or partially weight-bearing. The segmental rectus abdominis free flap is recommended for the reconstruction of such wounds.     

Configurations of the rectus abdominis muscle of anuran tadpoles

Configurations of the rectus abdominis in tadpoles of 60 anuran species in 13 families were examined. This muscle is present by Gosner stage 25 and does not change until late in metamorphosis. The anterior terminus of the r. abdominis usually is a straight, transverse front or fan-shaped array only loosely associated with the rectus cervicis. In some suspension feeders (Rhinophrynus, Xenopus, but not microhylids), macrophagous suction feeders (Lepidobatrachus) and bromeliad inhabitants (Hyla bromeliacia) the r. abdominis is contigous with the r. cervicis which continues anterolaterally and dorsally from the wall of the spiracular cavity. Suctorial forms (Scutiger), those that live in confined spaces (burrowers, Centrolenella; bromeliad inhabitants, Hyla bromeliacia), and the taxa that have the r. cervicis and r. abdominis contiguous all have closed myosepta; the myosepta of other taxa; except for ones with large tadpoles (e.g., Rana catesbeiana), have large gaps between at least anterior myotomes. These initial data suggest that the configurations of the r. abdominis have responded to selection based on ecomorphological function and convergence among lineages are noted. © 1992 Wiley-Liss, Inc.     

Reconstruction of ablated rat rectus abdominis by muscle regeneration

Skeletal muscle regeneration is a powerful, naturally occurring process of tissue reconstruction that follows myofiber damage secondary to myotoxic injury that does not normally affect the tissue circulation and scaffold. The ablated tissue, in traumatology and free muscle grafts, is frequently replaced by scars. The final outcome is poor even after in situ myoblast seeding of the harvested muscle. The goal of this study was to identify protocols to reconstruct muscle tissue, even in such adverse environments. The authors applied a step-by-step approach to identify factors favoring the survival of autologous satellite cells and, thus, muscle regeneration. In a rat model of full-thickness rectus abdominis muscle ablation, autologous myoblasts were isolated from the explanted rectus abdominis and seeded in a homologous acellular matrix immediately after wall reconstruction (group 1, five animals). In group 2 (five animals), the ablated rectus abdominis was autografted in situ. In a third group of five rats, Marcaine was injected into both the autograft and the surrounding abdominal wall muscle. Three weeks after surgery, serial cross-sections of the reconstructed abdominal wall were stained with hematoxylin and eosin or embryonic myosin antibody, a well-characterized molecular marker of early myogenesis in development and regeneration. Percentages of the patch area covered by regenerated myofibers were determined by morphometry. When autologous myoblasts were seeded in a homologous acellular matrix, the only myofibers observed to regenerate were those along the border of the patch. Autografting of the middle third of the rectus abdominis muscle similarly resulted in scar formation. The few muscle cells in the graft core were scanty myoblasts that could be detected only by monoclonal embryonic myosin antibody. Although negative for myofiber regeneration, the results in both cases confirmed the mechanical patency of the patches with regard to abdominal organ support. Myofibers were successfully regenerated in the graft by injecting Marcaine into both the autograft and the surrounding muscles. Three weeks after surgery, the patch was paved with young, centrally nucleated myofibers intermixed with young myofibers and myotubes expressing embryonic myosin. The difference in percentage of patch area covered by regenerated myofibers in group 3 (Marcaine injection around the patch, 81.6 +/- 3.0 percent) (mean +/- SD) versus either group 1 (Myoblast-seeded acellular patch, 18.0 +/- 3.0 percent) or group 2 (Autograft, 25.8 +/- 7.0 percent) was statistically significant on independent t test analysis (p < 0.0001). Even an acellular matrix showed some myofiber regeneration after surrounding muscles had been injected with Marcaine. This is the first successful evidence of muscle reconstruction after full-thickness ablation of the middle third of the rectus abdominis. Muscle regeneration seems to be the result of successive waves of migration of angioblasts and then satellite cell-derived myoblasts from the muscles surrounding the patch. The results strongly suggest that vascularization of the scaffold and successive coordinate proliferation of the seeded cells are required for myoblasts to be able to migrate into the patch and differentiate up to myofiber stage.     

Growth and metamorphosis of the rectus abdominis muscle in Rana pipiens

Cross sections through the middle segment of the anuran rectus abdominis muscle were analyzed morphometrically at nine stages of development, from early larval life through full maturity. The numbers, sizes, and relative distributions of twitch and slow muscle fibers, newly differentiated fibers, degenerating fibers, and satellite cells were determined at each stage. The data indicate that the muscle increases slowly in size and fiber content during early larval life. New fibers appear to form primarily along the medial margin of the muscle. During mid-larval stages, when thyroid hormone levels are rising, new fibers form throughout the medial portion of the muscle. At a slightly later stage, fibers in the lateral region of the muscle begin to degenerate. Structurally normal presynaptic elements are present on both degenerating fibers and the empty basal laminae of fibers that had been removed by phagocytes. Both fiber formation and fiber loss slow during midmetamorphic climax, at the time when thyroid hormone levels reach a peak in anurans and begin to decline. Degenerating fibers appear within the body of the muscle at the end of metamorphosis. By the end of the second postmetamorphic month, neither degenerating nor newly differentiated fibers are present. The muscle continues to grow through adult life primarily by fiber hypertrophy.     

Transneuronal tracing of neural pathways influencing both diaphragm and genioglossal muscle activity in the ferret.

In prior experiments that employed the transneuronal transport of isogenic recombinants of pseudorabies virus (PRV), we demonstrated that neurons located ventrally in the medial medullary reticular formation (MRF) of the ferret provide collateralized projections to both diaphragm and abdominal muscle motoneurons as well as to multiple abdominal muscle motoneuron pools. The goal of the present study was to determine whether single MRF neurons also furnish inputs to diaphragm motoneurons and those innervating an airway muscle with inspiratory-related activity: the tongue protruder genioglossus. For this purpose, PRV recombinants expressing unique reporters (beta-galactosidase or enhanced green fluorescent protein) were injected into either the diaphragm or the genioglossal muscle. The virus injections produced transneuronal infection of overlapping populations of MRF neurons. A small proportion of these neurons (<15%) was infected by both PRV recombinants, which indicated that they provide collateralized inputs to genioglossal and diaphragm motoneurons. These findings show that, whereas some MRF neurons simultaneously influence the activity of upper airway and respiratory pump muscles, other cells in this brain stem region independently contribute to diaphragm and genioglossal muscle contraction regulation.     

Electromyographic comparison of the upper and lower rectus abdominis during abdominal exercises

The objective of this pilot study was to determine the effect of 6 different abdominal exercises on the electrical activity of the upper rectus abdominis (URA) and lower rectus abdominis (LRA). Eight healthy, adult volunteers completed 6 random abdominal exercises: curl up, Sissel ball curl up, Ab Trainer curl up, leg lowering, Sissel ball roll out, and reverse curl up. Action potentials were recorded and analyzed from the URA and the LRA using surface electromyography (EMG) during a 2-second concentric contraction. The average normalized data were compared between the URA and the LRA in order to determine the behavior of the different muscle sites and between exercises in order to determine which exercises elicited the highest EMG activity. There were no significant differences (p > 0.05) between the EMG activity of the URA and LRA during any exercise. There were no significant interactions between subject and muscle site or between exercise and muscle site. Significant differences were found among the 6 exercises performed, and due to the interaction between subject and exercise performed. Both the URA and the LRA recorded significantly higher mean amplitudes during the Sissel ball curl up than during all other exercises. In addition, the curl up, Sissel ball curl up, and Ab Trainer curl up had significantly higher normalized EMG activity in both muscle sites than the reverse curl up, the leg lowering exercise, and the Sissel ball roll out. The curl up and the Ab Trainer curl up exercises were not significantly different in terms of their normalized EMG activities for both the URA and the LRA.     

The inferiorly based rectus abdominis myocutaneous flap for reconstruction of recurrent pressure sores.

Eight neurologically impaired patients underwent reconstruction of chronic perineal and ischial pressure sores utilizing an inferiorly based rectus abdominis myocutaneous flap. Other local and regional flap options had been previously used or were not feasible. In six patients, healing was uncomplicated. One patient required local debridement and flap readvancement. The second involved minor separation of a suture line and healed by secondary intention. All donor sites were closed directly and healed by primary intention. There was no evidence of hernia formation, and no functional deficit was detected from removal of the rectus muscle in any of the patients. In conclusion, it was felt that the inferiorly based rectus abdominis myocutaneous flap should be considered a reconstructive option in dealing with perineal and ischial pressure sores. Furthermore, for reasons discussed, we found distinct advantages to using this flap in spinal cord injury patients.     

Retroperitoneal transposition of rectus abdominis myocutaneous flaps to the perineum and back

Rectus abdominis myocutaneous flaps may be transposed through the retroperitoneum to reconstruct defects of the back and perineum. Cadaver dissections and clinical cases are presented to demonstrate the surgical technique and reconstructive possibilities of this flap.     

Neuromuscular efficiency of the rectus abdominis differs with gender and sport practice

The purpose of this investigation was to distinguish the abilities of the rectus abdominis (RA) muscle according to gender and sport training by means of neuromuscular parameters extracted from electromyography (EMG)-torque relationships. Thirty-eight healthy students, divided into 4 groups (i.e., 8 male runners, 10 female gymnasts, 12 male controls, and 8 female controls) were asked to perform 6 seconds of isometric trunk flexions at 20%, 25%, 75%, and 100% of their maximal voluntary contraction. Flexion torque and surface EMG of the RA muscle were recorded simultaneously to construct a EMG-torque relationship. Under maximal and submaximal conditions, an index of neuromuscular efficiency (NME) was determined to characterize the capacity of the RA muscle to develop a torque. At each level of contraction, the area of data scattering (ADS), reflecting torque and EMG fluctuations, was computed to express the capacity to maintain a constant target torque. Flexion torque, NME, and ADS values differed significantly between genders, but when data were related to anthropometric characteristics, no difference was observed. Although runners were not distinguished from male controls, gymnasts had higher flexion torque, higher NME, and lower ADS values than female controls had. These differences should reflect neural and muscular adaptations linked to the specificity of gymnastic training. These findings revealed different functional abilities of the RA muscle, according to gender and sport practices. The indices of neuromuscular capacities used in this study could constitute complementary tools to athletic trainers and professionals in sports medicine for evaluating and following, during sport-specific training programs, the abdominal muscle performance implied in force transfers with a lower cost and lower risks of back pain.