Mapping traction strength of the anterior rectus sheath in cadaver

Romar Ângelo Barbato Silveira,Yara Juliano,Volney Marques Passos,Fábio Xerfan Nahas,Felix Carlos Ocariz Bazzano,Bernardo Hochman,Lydia Masako Ferreira,Carlos Roberto Amorim

doi:10.1590/s0102-86502010000400009

Abstract

The tension at the aponeurotic edges of abdominal wall defects is an important factor of dehiscence and incisional hernia formation. The purpose of this study is to map and compare the traction force necessary for medial mobilization in various levels of the anterior rectus sheath in cadavers. Twenty four adult male cadavers, raging from 22 to 59 years old, with the abdominal wall intact and without prior preservation techniques, were dissected. A complete excision of the linea alba was performed. Traction loops of 10 mm in diameter were made in the anterior rectus sheath and were placed: 2, 4, 6 and 8 cm below the lower edge of the umbilicus and 3, 6 and 9 cm above the upper edge of the umbilicus. Each loop was mobilized 10 mm in the medial direction, using an analog dynamometer. The values obtained in each level were compared using Friedman's analysis of Variance for p < 0.05. The average traction values obtained at the various levels were compared and there was no statistical significant difference. There is no variation in tension along the whole extension of the anterior rectus sheath.

Highlights

Laparotomy is one of the most common surgical procedures in medical practice1-6
The following cadavers were excluded from the study: those who were less than 18 years and more than 60 years old, those with more than 24 hours since death, those that had been submitted to low temperatures or previous laparotomies, those with hernias of the abdominal wall, and cadavers with intraperitoneal disease, which would restrict the mobility of the abdominal wall
The values obtained in each level were inserted in the formula used to calculate the traction index5,6,10

Summary

Introduction

Laparotomy is one of the most common surgical procedures in medical practice. Median incision is the main access to the abdominal cavity. The incidence of hernias varies from 0 to 6% of all laparotomies. The incidence of hernias varies from 0 to 6% of all laparotomies7 This complication may be related to factors such as patient’s age, malnutrition, obesity, infection, jaundice, anemia, diabetes, renal insufficiency and neoplasias. Other factors such as the use of cytostatics and corticosteroids, as well as mechanical factors that lead to an increase in abdominal pressure, may be involved in the incidence of this type of abdominal wall defect. Mapping traction strength of the anterior rectus sheath in cadaver

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Conclusion