CC BY-NC 4.0 · Arch Plast Surg 2013; 40(04): 359-366
DOI: 10.5999/aps.2013.40.4.359
Original Article

Anatomical and Functional Recovery of Neurotized Remnant Rectus Abdominis Muscle in Muscle-Sparing Pedicled Transverse Rectus Abdominis Musculocutaneous Flap

Woonhyeok Jeong
Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
,
Daegu Son
Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
,
Hyeonjung Yeo
Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
,
Hoijoon Jeong
Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
,
Junhyung Kim
Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
,
Kihwan Han
Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
,
Soyoung Lee
Department of Rehabilitation Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
› Author Affiliations
This article was presented at the Research and Reconstructive Forum on May 12-13, 2011 in Daejeon, Korea.

Background Pedicled transverse rectus abdominis musculocutaneous flaps typically sacrifice the entire muscle. In our experience, the lateral strip of the rectus abdominis muscle can be spared in an attempt to maintain function and reduce morbidity. When the intercostal nerves are injured, muscle atrophy appears with time. The severed intercostal nerve was reinserted into the remnant lateral strip of the rectus abdominis muscle to reduce muscle atrophy.

Methods The authors retrospectively reviewed 9 neurotized cases and 10 non-neurotized cases. Abdominal computed tomography was performed to determine the area of the rectus muscles. Electromyography (EMG) was performed to check contractile function of the remnant muscle. A single investigator measured the mean areas of randomly selected locations (second lumbar spine) using ImageJ software in a series of 10 cross-sectional slices. We compared the Hounsfield unit (HU) pre- and postoperatively to evaluate regeneration quality.

Results In the neurotization group, 7 of 9 cases maintained the mass of remnant muscle. However, in the non-neurotization group, 8 of 10 lost their mass. The number of totally atrophied muscles in each of the two groups was significantly different (P=0.027). All of the remnant muscles showed contractile function on EMG. The 9 remaining remnant rectus abdominis muscles showed declined the HU value after surgery but also within a normal range of muscle.

Conclusions Neurotization was found to be effective in maintaining the mass of remnant muscle. Neurotized remnant muscle had contractile function on EMG and no fatty degeneration by HU value.

The authors thank Dr. Yang for the medical illustrations.




Publication History

Received: 07 March 2013

Accepted: 13 June 2013

Article published online:
01 May 2022

© 2013. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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