Rectus Abdominis Research Articles

Are trunk muscle sizes different between acute lumbar spondylolysis and nonspecific low back pain?

IntroductionMorphological differences in the trunk muscles between adolescent athletes with lumbar spondylolysis (LS) and nonspecific low back pain (NSLBP) have not been fully elucidated. This study aimed to investigate the differences in physiological cross-sectional areas (CSA) of the trunk muscles between athletes with acute LS and those with acute NSLBP. MethodsMagnetic resonance images of 48 patients aged 13–14 years diagnosed with acute LS or NSLBP were retrospectively evaluated. The CSA of the paraspinal, psoas major, and rectus abdominis muscles at the L4-5 intervertebral disc level were measured. ResultsCSA of the left and right paraspinal muscles in the acute LS group were significantly larger than those in the acute NSLBP group (left: mean difference, 276.0 mm2; 95% confidence interval [CI], 68.5–483.6 mm2; P = 0.01; right: mean difference, 228.8 mm2; 95% CI, 7.6–450.1 mm2; P = 0.04). The ratio between the left paraspinal muscles and left psoas major in the acute LS group was significantly larger than that in the acute NSLBP group (mean difference, 0.2; 95% CI, 0.0–0.4; P = 0.03). ConclusionsTrunk muscle size may differ between adolescent athletes with acute LS and those with NSLBP. Future research involving healthy controls is required to better understand the morphological characteristics of these injuries.

Association between expiratory mouth pressure and abdominal muscle activity in healthy young males.

To clarify the association between forced expiration and the abdominal muscles by assessing the relationship between expiratory mouth pressure and abdominal muscle activity in healthy young males. Twenty-five males underwent forced expiration at 20, 30, 50, 75, and 100% of the maximal expiratory mouth pressure. Mouth pressure was measured using a bridge-type transducer connected to a mouth pressure meter. Abdominal crunch, twist crunch, and abdominal hollowing at maximal voluntary contraction were also performed. During forced expiration and abdominal exercises, the activity of the rectus abdominis (RA), oblique externus abdominis/oblique internus abdominis (OE/OI), and OI/transversus abdominis (OI/TrA) was measured using surface electromyography. The determination coefficient (r2) for the linear relationship between mouth pressure and abdominal muscle activity was 0.86 ± 0.15 for the RA, 0.93 ± 0.06 for the OE/OI, and 0.90 ± 0.14 for the OE/OI. The slope of the linear relationship with r2 ≥ 0.50 showed no significant difference between the RA (0.22 ± 0.27) and the OE/OI (0.27 ± 0.21). However, it was significantly greater in the OI/TrA (1.78 ± 1.41) than in the RA and OE/OI. The OE/OI activity was significantly lower in the maximal forced expiration than in twist crunch, and the OI/TrA activity was not significantly greater in the maximal forced expiration than in twist crunch. All abdominal muscles contribute to forced expiration with a greater contribution of the OI and TrA than the RA and OE. Furthermore, the contribution of the TrA would be greater than that of the OI.

Issue Information

The pyramidal muscle (PM) is a paired small triangular muscle of the anterior abdominal wall. Its physiological significance is unclear. The present study used high‐resolution MRI to determine when the PM emerged and revealed its features. The PM was first detected at Carnegie stage (CS)20 and in five of the seven samples between CS21 and CS23. 81.4% of samples during the early fetal period had PM on both the right and left sides. The frequency, side differences, sex dimorphism, and spatial position of the PM in the early fetal period were similar to those in adults.FIGURE: Representative images of the PM (CRL: 58.7 mm). (A) T1W MR image. (B) 3D‐reconstructed image showing the PM (red), rectus abdominis muscle (purple). (C) Diffusion tensor image showing the PM and rectus abdominis muscles. Further details can be seen in the article by Iwasa et al. in this issue.image

New Anatomical Concepts regarding Pubic-Related Groin Pain: A Dissection Study

ObjectivePubis-related groin pain remains a difficult topic in orthopedic and sports medicine. A better understanding of the anatomy of the adductors and the pubic ligaments is necessary. The aim of this study is to map all the musculotendinous attachments to the pubic ligaments and to investigate in detail all the possible inter-adductor fusions. MethodsThe pubic symphyses were dissected in eight male and fourteen female embalmed cadavers (mean age 85 years), focusing on the fusion between the adductors, pubic ligaments, and musculotendinous attachments at the pubic ligaments. The 95% confidence intervals for the prevalence of the different conjoint tendons and tendon attachment to ligament were calculated. ResultsThe presence of three types of conjoint tendons was found: adductor brevis and gracilis (AB/G) 90.9 [72.2 – 97.5]%; adductor brevis and adductor longus (AB/AL) 50.0 [30.7 – 69.3]%; adductor longus and gracilis (AL/G) 50.0 [30.7 – 69.3]%. The AL, AB and G were in every cadaver attached to the anterior pubic ligament (APL). 64% of the AB and 100% of the G were attached to the inferior pubic ligament (IPL). ConclusionThe proximal anatomy of the adductors is more complex than initially described. This study identified three possible conjoint tendons between the proximal adductors. The AB/G conjoint tendon was significantly more present than the AB/AL or AL/G conjoint tendon. The IPL has attachments only from the AB and G. Rectus Abdominis (RA) and AL were not attached to IPL. Mapping the musculotendinous attachments on the pubic ligaments creates more clarity on the pathophysiology of lesions in this area.

Trunk Muscle Function and Core Stability in Women Who Had Muscle-Sparing Pedicled Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction.

The long-term effects of the unilateral muscle-sparing pedicled transverse rectus abdominis myocutaneous (TRAMmsp) flap procedure on trunk muscle performances and core stability were investigated in women with breast cancer. Forty women (mean age = 42.6years) who had received breast reconstruction with the unilateral TRAMmsp flap procedure no less than 6months earlier (mean = 10.3 [standard deviation, SD = 4.9] months) (TRAM group) participated, and 30 women who were healthy and matched for age (mean age = 41.2years) served as controls (control group). Their abdominal and back muscle strength was assessed using the curl-up and prone extension tests, respectively, and their static abdominal muscle endurance and back extensor endurance were assessed using the sit-up endurance test in the crook-lying position and the Biering-Sørensen test, respectively. Core stability strength was assessed using a 4-level limb-lowering test (abdominal muscle test), and core stability endurance was assessed while lying supine with both flexed legs 1 inch off the mat while keeping the pelvis in a neutral position with a pressure biofeedback unit. Compared with the control group, trunk muscles of the TRAM group were weaker, showing less endurance, as were their core stability strength and endurance. Static trunk muscle endurances and trunk flexion strength were associated with core stability in both groups. Women exhibit trunk flexor and extensor weakness along with poor endurance and impaired core stability even after an average of 10months from receiving the TRAMmsp flap procedure. Immobilization after surgery, with possible systemic inflammatory effects from surgery and chemotherapy, might have further contributed to the generalized weakness subsequent to the partial harvesting of the rectus abdominis. Women after breast reconstruction with the TRAMmsp flap procedure show long-lasting deficits of strength and endurance in abdominal muscles, back extensors, and core stability. Proactive measures including early detection and evaluation of impairments as well as timely intervention targeting these clients are important to minimize the dysfunction and support their return to community participation.

Effects of the walking independence on lower extremity and trunk muscle activity during straight-leg raising following incomplete cervical cord injury

The purpose of this study was to compare the acceleration and surface electromyography (EMG) of the lower extremity and trunk muscles during straight-leg raising (SLR) in patients with incomplete cervical cord injury according to their levels of walking independence. Twenty-four patients were measured acceleration and EMG during SLR held for 10 s. Data were analyzed separately for the dominant and nondominant sides and compared between the nonindependent (NI) and independent (ID) groups based on their levels of walking independence. Frequency analysis of the EMG showed that the high-frequency (HF) band of the contralateral biceps femoris (BF) in the ID group and bands below the medium-frequency (MF) of the BF and the HF and MF bands of the rectus abdominis in the NI group were significantly higher during dominant and nondominant SLR. During the nondominant SLR, the low-frequency band of the internal oblique and the MF band of the external oblique were significantly higher in the NI group. The ID group mobilized muscle fiber type 2 of the BF, whereas the NI group mobilized type 1 of the BF and types 2 and 1 of the trunk muscles to stabilize the pelvis. This result was more pronounced during the nondominant SLR.

The primary prevention of pancreatic fistula using a vascularised rectus abdominis muscle flap – A porcine model

A pancreatic fistula is one of the most devastating complications following a Whipple's procedure. Fistula rates remain high despite various modifications to surgical techniques. We propose the use of a vascularised muscle flap in the primary prevention of pancreatic fistulas. A distal pancreatectomy was performed on 5 pigs in our porcine model. A pancreaticojejunal (PJ) anastomotic leak was simulated. The pigs were divided into treatment (4 pigs) and control groups (1 pig). A left pedicled rectus abdominis flap was wrapped around the PJ anastomosis for the treatment group and omitted for the control group. Serum and drain amylase levels were recorded. The PJ-rectus abdominis flap complex was evaluated histologically. There was no biochemical evidence of anastomotic leak in the treatment group. The drain-serum amylase ratio was less than 1.5 in the treatment group (p=0.006). Microscopically, the muscle adjacent to the anastomotic leak showed mild necrotic changes with an affected muscle depth of less than 10%. The vascularised rectus abdominis muscle is a durable flap to withstand proteolytic pancreatic enzymes. It is able to provide a water-tight seal around the PJ anastomosis and mitigate intraperitoneal haemorrhage and infection caused by erosion from the pancreatic fistula.

Frequency of Diastasis Recti in Second and Third Trimesters of Pregnancy in Jinnah Hospital Lahore. A Cross-Sectional Study

Background: Diastasis Recti (DR) is a condition characterized by the separation of the rectus abdominis muscles, commonly occurring among pregnant women. Despite its prevalence, awareness of DR and its implications remains low. This study aims to investigate the frequency of DR in the second and third trimesters of pregnancy and to identify any associated risk factors. Objective: To determine the prevalence of DR among pregnant women in their second and third trimesters and to assess the level of awareness about the condition. Additionally, the study seeks to explore the relationship between DR and potential risk factors such as the number of pregnancies, Body Mass Index (BMI), and engagement in abdominal muscle exercises. Methods: This cross-sectional study was conducted at Jinnah Hospital Lahore, involving 64 pregnant women in their second and third trimesters. Participants were selected through non-probability convenience sampling. DR was assessed using the Finger width method, alongside a questionnaire to gather demographic information and assess awareness levels. Statistical analysis was performed using SPSS version 25, focusing on descriptive statistics to summarize demographic data, and chi-square tests to explore associations between DR and identified risk factors. Results: Among the 64 participants, DR was present in 45.3% (29/64) of the sample, with a higher prevalence observed in the third trimester. The majority of participants (90.6%) reported never performing abdominal muscle exercises. A systematic review indicated that antenatal exercises could reduce DR cases by approximately 35%. However, awareness of DR among participants was notably lacking, with none having prior knowledge of the condition. Additionally, there was no significant association between DR and BMI, or the frequency of abdominal exercises. Conclusion: DR is a prevalent condition among pregnant women, particularly in their third trimester, with a significant lack of awareness observed. While the number of pregnancies appears to be a contributing factor, other explored risk factors such as BMI and engagement in abdominal exercises did not show a significant association with DR. These findings highlight the need for increased educational efforts and further research to better understand and manage DR during pregnancy.

Enhanced Recovery after Surgery in Open Fetal Spina Bifida Repair

Introduction: For open fetal spina bifida (fSB) repair, a maternal laparotomy is required. Hence, enhanced maternal recovery after surgery (ERAS) is paramount. A revision of our ERAS protocol was made, including changes in operative techniques and postoperative pain management. This study investigates eventual benefits. Methods: Our study included 111 women with open fSB repair at our center. The old protocol group (group 1) either received a transverse incision of the fascia with transection of the rectus abdominis muscle (RAM) or a longitudinal incision of the fascia without RAM transection, depending on placental location. The new protocol required longitudinal incisions in all patients (group 2). Postoperative pain management was changed from tramadol to oxycodone/naloxone. Outcomes of the two different protocol groups were analyzed and compared regarding the primary endpoint, the length of hospital stay (LOS) after fetal surgery, as well as regarding the following secondary endpoints: postoperative pain scores, day of first mobilization, removal of urinary catheter, bowel movement, and the occurrence of maternal and fetal complications. Results: Out of 111 women, 82 (73.9%) were in group 1 and 29 (26.1%) were in group 2. Women in group 2 showed a significantly shorter LOS (18 [14–23] days vs. 27 [18–39] days, p = 0.002), duration until mobilization (3 [2–3] days vs. 3 [3–4] days, p = 0.03), and removal of urinary catheter (day 3 [3–3] vs. day 4 [3–4], p = 0.004). Group 2 less often received morphine subcutaneously (0% vs. 35.4%, p < 0.001) or intravenously (0% vs. 17.1%, p = 0.02) but more often oxycodone (69.0% vs. 18.3%, p < 0.001). No significant differences were seen regarding pain scores, bowel movement, and maternal and/or fetal complications. Conclusion: The new ERAS protocol that combined changes in surgical technique and pain medication led to better outcomes while reducing LOS. Continuous revisions of current ERAS protocols are essential to improve patient care continuously.

Safety and efficacy of stoma site selection in CT-guided percutaneous gastrostomy: a retrospective analysis.

To compare the safety and efficacy of CPG in the rectus abdominis and intercostal regions. This retrospective study included 226 patients who underwent CPG at a single center, with the stoma placed in the rectus abdominis or intercostal region. Surgical outcomes and complications, such as pain and infection within 6months postoperatively, were recorded. The surgical success rate was 100%, and the all-cause mortality rate within 1month was 0%. An intercostal stoma was placed in 56 patients; a rectus abdominis stoma was placed in 170 patients. The duration of surgery was longer for intercostal stoma placement (37.66 ± 14.63min) than for rectus abdominis stoma placement (30.26 ± 12.40min) (P = 0.000). At 1month postsurgery, the rate of stoma infection was greater in the intercostal group (32.1%) than in the rectus abdominis group (20.6%), but the difference was not significant (P = 0.077). No significant difference was observed in the infection rate between the two groups at 3 or 6months postsurgery (P > 0.05). Intercostal stoma patients reported higher pain scores during the perioperative period and at 1month postsurgery (P = 0.000), but pain scores were similar between the two groups at 3 and 6months postsurgery. The perioperative complication rates for intercostal and rectus abdominis surgery were 1.8% and 5.3%, respectively (P = 0.464), with no significant difference in the incidence of tube dislodgement (P = 0.514). Patient weight improved significantly at 3 and 6months postoperatively compared to preoperatively (P < 0.05). Rectus abdominis and intercostal stomas have similar safety and efficacy. However, intercostal stomas may result in greater short-term patient discomfort.

Effect of different cranio-cervical positions on abdominal and back muscles activities from different postures: A cross-section study

The aim of this study was to investigate whether changing cranio-cervical postures is associated with changes in abdominal and back muscle activities during bridging and plank positions, and to present the importance of cranio-cervical posture control during trunk stabilization exercises. This was a cross-sectional study that included thirty patients (21 men and 9 women), aged between 18 and 30 years, with no history of previous spinal surgery, other severe musculoskeletal disorders, or neurological disorders, selected from Cairo University's Faculty of Physical Therapy. Every patient was requested to adopt a bridging and a plank position. Surface Electromyography (EMG) was used to assess muscular activation patterns by measuring muscle activity amplitudes. EMG signals of rectus abdominus and lumbar erector spinae in different cranio-cervical postures (extension 25°, neutral, and flexion 25°) were compared. The cranio-cervical posture was controlled utilizing a cervical range of motion device (CROM). Cranio-cervical posture was found to significantly influence trunk muscle activities (p=0.001), with cranio-cervical flexion yielding the highest activity in the rectus abdominus in both bridging (p=0.001) and plank positions (p=0.001), while cranio-cervical extension yielded the highest activity in the lumbar erector spinae in both bridging (p=0.001) and plank positions (p=0.017). Cranio-cervical flexion increased rectus abdominus muscle activity during the bridging and plank positions, while cranio-cervical extension improved lumbar erector spinae muscle activity during the bridging and plank positions. Consideration of cranio-cervical posture is suggested when carrying out trunk stabilization exercises.

Soft-tissue reconstruction with pedicled vertical rectus abdominis myocutaneous flap after total or high sacrectomy for giant sacral tumor

BackgroundThe large soft tissue defect after total or high sacrectomy for giant sacral tumor induces high incidence of wound complications. It remains a huge challenge to reconstruct the soft tissue defect with a preferred clinical outcome. MethodsA total of 27 patients undergoing one-stage total or high sacrectomy for giant sacral tumor between 2016 and 2021 in a tertiary university hospital were retrospectively reviewed. Thirteen patients underwent a pedicled vertical rectus abdominis myocutaneous (VRAM) flap reconstruction while 14 patients underwent a conventional wound closure. Patient’s clinical characteristics, surgical duration, postoperative complications and outcomes were compared between the two groups. ResultsPatients in VRAM and Non-VRAM group were similar in baseline characteristics. The mean tumor size was 12.85cm (range: 10~17cm) in VRAM group and 11.79cm (range: 10~14.5cm) in Non-VRAM group (P=0.139). The most common giant sacral tumor is chordoma. Patients in VRAM group had shorter length of drainage (9.85 vs 17.14 days), postoperative time in bed (5.54 vs 17.14 days), and total length of stay (19.46 vs 33.36 days) compared to patients in Non-VRAM group. Patients in VRAM group had less wound infection and debridement than patients in Non-VRAM group (15.4 vs 57.1%, P<0.001). ConclusionThis study demonstrates the advantages of pedicled VRAM flap reconstruction of large soft tissue defects after high or total sacrectomy when using the anterior-posterior approach. This choice of reconstruction is better than direct wound closure in terms of wound infection, length of drainage, and total length of stay.

Comparison of complications and functional outcomes following total or subtotal glossectomy with laryngeal preservation using a deep inferior epigastric artery perforator free flap versus a rectus abdominis musculocutaneous free flap

ObjectiveWide defects resulting from subtotal or total glossectomy are commonly reconstructed using a bulk flap to maintain oral and speech functions. The flap, including muscle tissue, diminishes with time. This study aimed to compare the surgical outcomes of deep inferior epigastric artery perforator and rectus abdominis musculocutaneous free flap reconstructions after glossectomy with laryngeal preservation. MethodsMedical records of 13 and 26 patients who underwent deep inferior epigastric artery perforator and rectus abdominis musculocutaneous free flap reconstructions, respectively, from 2014 to 2022 at our institution were reviewed. Patients who underwent middle pharynx resection except for the base of the tongue, mandibular bone resection, and sensory reinnervation were excluded. ResultsThe rectus abdominis musculocutaneous groups showed a higher number of lymph node dissection and shorter operative time than the deep inferior epigastric artery perforator groups. No significant differences in postoperative complications or functional oral intake scale scores at 6 months were observed. Volumetric changes on computed tomography images at 6 and 12 months were significantly lower in the deep inferior epigastric artery perforator group. Cancer recurrence was significantly associated with reduced oral function. ConclusionOral function in patients with cancer is influenced by various other factors. However, the deep inferior epigastric artery perforator flap may be suitable for tongue reconstruction because of the minimal postoperative changes in flap volume, easy adjustment of flap thickness, elevation of multiple flaps, and minimal complications at the donor site.

MRI findings in athletic groin pain: correlation of imaging with history and examination in symptomatic and asymptomatic athletes.

To determine differences in prevalence and diagnostic accuracy of MRI findings between asymptomatic athletes and athletes with longstanding groin pain. One hundred twenty-three adult male athletes were approached with 85 consecutive athletes recruited. Group 1 (symptomatic, n = 34) athletes referred for longstanding groin pain (insidious onset, > 3 weeks duration). Group 2 (control, n = 51) athletes referred for injuries remote from the pelvis and no groin pain in the last 12 weeks. All referrers completed a clinical examination proforma documenting absence or presence of pelvis and hip abnormality. All patients completed the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire and underwent a 3T MRI groin and hip protocol. MRIs were scored independently by two musculoskeletal radiologists blinded to clinical details. Statistical analysis was performed to evaluate associations between MRI findings, inter-reader reliability, clinical examination and HAGOS scores. Pubic body subchondral bone oedema, capsule/aponeurosis junction tear and soft tissue oedema were more prevalent in the symptomatic group (p = 0.0003, 0.0273 and 0.0005, respectively) and in athletes with clinical abnormality at symphysis pubis, adductor insertion, rectus abdominis, psoas and inguinal canal (p = 0.0002, 0.0459 and 0.00002, respectively). Pubic body and subchondral oedema and capsule/aponeurosis tear and oedema significantly correlated with lower (worse) HAGOS scores (p = 0.004, 0.00009, 0.0004 and 0.002, respectively). Inter-reader reliability was excellent, 0.87 (range 0.58-1). Symphyseal bone spurring, disc protrusion and labral tears were highly prevalent in both groups. Clinical assessment and MRI findings of pubic subchondral bone oedema and capsule/aponeurosis abnormality appear to be the strongest correlators with longstanding groin pain.

Preoperative frailty assessment with ultrasound in elderly patients scheduled for total knee arthroplasty.

Frailty, a decline in physical and cognitive reserve capacity, renders patients susceptible to various stressors and has been linked to adverse outcomes and increased healthcare utilization. This study aimed to determine whether ultrasound measurements of the rectus abdominis (RA) and biceps brachii (BB) could predict frailty in patients scheduled for total knee arthroplasty. Frailty was assessed using the Clinical Frailty Scale in adults aged ≥60 years. Ultrasound measurements of the rectus abdominis, BB, and quadriceps femoris muscles, along with thigh circumference measurements, were obtained before surgery. The predictive ability of the unadjusted and BMI- and body surface area (BSA)-adjusted measurements were evaluated using receiver operating characteristic curve analysis and area under the curve (AUC) values. Postoperative outcomes, such as admission to the intensive care unit or skilled nursing facility, delirium, falls, re-hospitalization, and 30-day mortality were recorded. We analyzed data from 148 patients. BB thickness provided a fair prediction of frailty. Average measurements of both BB adjusted for BMI (0.708, 95% CI 0.602-0.814; P<0.001), and BSA (0.708, 95% CI 0.598-0.817; P<0.001) had the highest AUC values. RA muscle measurements could not discriminate frailty. The BMI-adjusted measurements for: right quadriceps femoris thickness (AUC 0.614, 95% CI 0.503-0.725; P=0.044), left thigh circumference (AUC 0.648, 95% CI 0.528-0.769; P=0.016), and average thigh circumference (AUC 0.630, 95% CI 0.511-0.750; P=0.033) had statistically significant but poor AUC values. Preoperative ultrasound measurements of the bilateral BB can fairly predict frailty in patients scheduled for total knee arthroplasty.

Endoscopic Mini- or Less-Open Sublay operation with transversus abdominis muscle release using a single-port platform for incisional hernia: A video vignette

The Endoscopic Mini- or Less-open Sublay operation (EMILOS) is a transhernial repair that allows endoscopic dissection and mesh placement in the retrorectus/retromuscular space, and simultaneous transversus abdominis release (TAR) for larger hernias. The operative summary is as follows. 1 A 7-cm longitudinal skin incision was made immediately above the hernial orifice. 2 The hernial sac was circumferentially dissected to the border of the defect, and the abdomen was opened. 3 The posterior rectus sheath (PRS) was incised approximately 5mm lateral to the medial border of the rectus sheath to enter the retrorectus space. 4 Exploratory laparoscopy was performed, and the peritoneum was closed. 5 A single port platform was attached to the wound, and the abdominal wall was insufflated. The retrorectal space was dissected laterally to the outer edge of the rectus abdominis muscle. The linea alba was incised at least 5cm cranially and caudally from the border of the hernia defect to obtain sufficient mesh overlap. 6 The TAR was added to the left side to facilitate medial advancement of the PRS. (7) The PRS was approximated with continuous suture. A self-gripping mesh was trimmed and implanted in the retrorectus space. The mesh was secured with 3-0 absorbable sutures (8) A closed-suction drain was placed on the mesh, and the wound was trimmed and closed. The postoperative course was uneventful. No recurrence was observed at 6-month follow-up. This technique may be advantageous because it allows minimal skin incision with physiological reconstruction of abdominal wall.

Macedo ileal catheterizable reservoir adding the scissors maneuver of channel continence: Long term follow-up

The Macedo ileal catheterizable channel was published in 2000 and consists of an enterocystoplasty with a catheterizable channel that precludes the need of the appendix for the efferent channel. After 25 years of experience with this technique, we decided to review our experience in a select subgroup of cases performed and followed exclusively by the author in a non-teaching hospital facility after the latest modifications of the procedure. Since 2008, we have refined our technique with the following modifications: small skin transverse incision instead of longitudinal one, with a semicircular flap for further stoma creation in the midline and importantly the scissors maneuver. This maneuver consists of crossing two 2cm rectus abdominis muscle flaps in the midline to create a neosphincter over the catheterizable channel. Follow-up was defined as the interval between the date of surgery and last visit to the clinic. We defined stoma continence if the dry interval between catheterization was 4hs. Early and late complications were reported as well as the reintervention rate. Additional procedures in association with bladder augmentation were also appointed. We have treated 49 patients. Indications were spinal dysraphism (71.4%), mainly myelomeningocele (65.3%), and others (PUV, exstrophy, anorectal anomalies). Urodynamic evaluation showed bladder pressure of high risk for upper urinary tract involvement (66%), urinary incontinence (24.5%), conversion of incontinent urinary diversion (3.8%), one exstrophy patient not considered (1.9%). Mean age at surgery was 88 months (7.3 years), 21 patients had additional surgeries in addition to Macedo ileal catheterizable channel: Macedo-Malone LACE procedure in 21 patients and bladder neck surgery to improve continence in 5 patients. Urinary stoma continence was 93.9% (46/49) after first surgery, one patient had a serous line valve revised, two patients still leak after 2h and await revision. Overall enterocystoplasty complications rate was 12.24% and consisted of urinary leakage in 3 cases and channel/stoma stricture in 3 cases. All patients treated for sphincteric deficiency associated with bladder reconstruction are continent per urethra. Urinary stoma revision for stricture was done in 2 cases and consisted on suprafascial approach and reanastomosis, one patient resolved with dilatation of the channel to the stoma. Mean follow up is 100 months (8.3 years). We confirmed in a long term follow-up based on face-to-face visits with 8.3 years mean follow-up that the Macedo procedure associated with the scissors maneuver is associated with 93.9% continence of the stoma. Overall complications rate was 12.24%. The cosmetic aspect with a small transverse incision and a midline stoma is another strength of the technique.

Electromyographic activity of core muscles in isometric pole dance exercises with thigh locks

There is little technical and scientific research on Pole Dancing — an artistic, sensual and sporting activity based on friction and opposition between the body and a bar. The objective of this study is to analyze and compare the electromyographic (EMG) activity of the rectus abdominis (RA), obliquus externus abdominis (OE), and erector spinae (ES) muscles during the execution of different isometric Pole Dance exercises using the thigh lock to fix the body on the bar in the vertical, horizontal and inverted positions (basic seat, plank seat, and inverted seat). Experimental study consisting of a convenience sample of ten female Pole Dance practitioners with more than one year of experience and physically active. The EMG signal obtained during all exercises was quantified in the time domain by root mean square (RMS) and normalized by maximal voluntary isometric contraction (MVIC). Data were collected using simple differential surface electrodes and analyzed using repeated-measures analysis of variance. The results showed a significant difference only for the ES muscle, which was higher for the inverted position when compared to the vertical and horizontal ones. The three exercises produced low to moderate EMG activity in the muscles analyzed. Therefore, these exercises can be prescribed both for Pole Dance training programs — its variations present interesting intensity progression — and for low back pain prevention, as they can improve trunk neuromuscular control.

Interposing Rectus and Gracilis Muscle Flaps For Pelvic Reconstruction in Bladder Exstrophy After Bladder Neck Closure.

The exstrophy-epispadias complex is a spectrum of ventral wall malformations including classic bladder exstrophy (CBE) and cloacal exstrophy (CE). Patients undergo multiple soft-tissues procedures to achieve urinary continence. If unsuccessful bladder neck closure (BNC) is performed, muscle flaps may be used to reinforce BNC or afterwards for fistula reconstruction. In this study, patients reconstructed using a rectus abdominis or gracilis muscle flap were reviewed. A retrospective cohort study of exstrophy-epispadias complex patients who underwent BNC and had a muscle fap was performed. Indication for flap use, surgical technique, risks for BNC failure including mucosal violations (MVs) were reviewed. MVs were prior bladder mucosa manipulation for exstrophy closure, repeat closure(s) and bladder neck reconstruction. Success was defined as BNC without fistula development. Thirty-four patients underwent reconstruction. Indications included during BNC (n=13), fistula closure after BNC (n=17), following BNC during open cystolithotomy (n=1) or fistula closure after open cystolithotomy (n=3). A vesicourethral fistula developed most frequently in CBE (88.9%) and vesicoperineal fistula in CE (87.5%). Thirty-three rectus flaps and 3 gracilis flap were used with success achieved in 97.1% and 66.7%, respectively. All 34 patients achieved success and 2 CE patients required a second flap. The rectus flap is preferred as it covers the antero-inferior bladder and pelvic floor to prevent urethral, cutaneous, and perineal fistula formation. The gracilis flap only reaches the pelvic floor to prevent urethral and perineal fistula development. Increased MVs, increase the risk of fistula formation and may influence the need for prophylactic flaps.

Muscular Strategies for Correcting the Pelvic Position to Improve Posture-An Exploratory Study.

The correction of postural weaknesses through the better positioning of the pelvis is an important approach in sports therapy and physiotherapy. The pelvic position in the sagittal plane is largely dependent on the muscular balance of the ventral and dorsal muscle groups. The aim of this exploratory study was to examine whether healthy persons use similar muscular activation patterns to correct their pelvic position or whether there are different motor strategies. The following muscles were recorded in 41 persons using surface electromyography (EMG): M. trapezius pars ascendens, M. erector spinae pars lumbalis, M. gluteus maximus, M. biceps femoris, M. rectus abdominis, and M. obliquus externus. The participants performed 10 voluntary pelvic movements (retroversion of the pelvis). The anterior pelvic tilt was measured videographically via marker points on the anterior and posterior superior iliac spine. The EMG data were further processed and normalized to the maximum voluntary contraction. A linear regression analysis was conducted to assess the relationship between changes in the pelvic tilt and muscle activities. Subsequently, a Ward clustering analysis was applied to detect potential muscle activation patterns. The differences between the clusters and the pelvic tilt were examined using ANOVA. Cluster analysis revealed the presence of four clusters with different muscle activation patterns in which the abdominal muscles and dorsal muscle groups were differently involved. However, the gluteus maximus muscle was involved in every activation pattern. It also had the strongest correlation with the changes in pelvic tilt. Different individual muscle patterns are used by different persons to correct pelvic posture, with the gluteus maximus muscle apparently playing the most important role. This can be important for therapy, as different muscle strategies should be trained depending on the individually preferred motor patterns.