DOCSLIB.ORG

The Pyramidalis–Anterior Pubic Ligament–Adductor Longus Complex (PLAC) and Its Role with Adductor Injuries: a New Anatomical Concept

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Pyramidalis–Anterior Pubic Ligament–Adductor Longus Complex (PLAC) and Its Role with Adductor Injuries: a New Anatomical Concept Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-017-4688-2 HIP The pyramidalis–anterior pubic ligament–adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept Ernest Schilders1,2,3 · Srino Bharam3,4 · Elan Golan5 · Alexandra Dimitrakopoulou2,6 · Adam Mitchell7 · Mattias Spaepen8 · Clive Beggs2 · Carlton Cooke9 · Per Holmich10,11 Received: 29 April 2017 / Accepted: 16 August 2017 © The Author(s) 2017. This article is an open access publication Abstract Results The pyramidalis is the only abdominal muscle Purpose Adductor longus injuries are complex. The anterior to the pubic bone and was found bilaterally in all confict between views in the recent literature and various specimens. It arises from the pubic crest and anterior pubic nineteenth-century anatomy books regarding symphyseal ligament and attaches to the linea alba on the medial border. and perisymphyseal anatomy can lead to difculties in MRI The proximal adductor longus attaches to the pubic crest and interpretation and treatment decisions. The aim of the study anterior pubic ligament. The anterior pubic ligament is also is to systematically investigate the pyramidalis muscle and a fascial anchor point connecting the lower anterior abdomi- its anatomical connections with adductor longus and rec- nal aponeurosis and fascia lata. The rectus abdominis, how- tus abdominis, to elucidate injury patterns occurring with ever, is not attached to the adductor longus; its lateral tendon adductor avulsions. attaches to the cranial border of the pubis; and its slender Methods A layered dissection of the soft tissues of the internal tendon attaches inferiorly to the symphysis with fas- anterior symphyseal area was performed on seven fresh-fro- cia lata and gracilis. zen male cadavers. The dimensions of the pyramidalis mus- Conclusion The study demonstrates a strong direct con- cle were measured and anatomical connections with adduc- nection between the pyramidalis muscle and adductor longus tor longus, rectus abdominis and aponeuroses examined. tendon via the anterior pubic ligament, and it introduces the 1 * Ernest Schilders Fortius Clinic, 17 Fitzhardinge Street, W1H 6EQ London, [email protected] UK 2 Srino Bharam School of Sport, Leeds Beckett University, Leeds, [email protected] West Yorkshire, UK 3 Elan Golan Orthopaedics, Lennox Hill Hospital, New York, NY, USA [email protected] 4 Mount Sinai School of Medicine, New York, NY, USA Alexandra Dimitrakopoulou 5 Orthopaedics, Maimonides Medical Center, Brooklyn, NY, USA [email protected] 6 The Wellington Hospital, The London Hip Arthroscopy Adam Mitchell Centre, London, UK [email protected] 7 Radiology, Fortius Clinic, London, UK Mattias Spaepen 8 [email protected] Radiology, GZA, Antwerpen, Belgium 9 Clive Beggs Leeds Trinity University, Leeds, West Yorkshire, UK [email protected] 10 Sports Orthopedic Research Center ‑ Copenhagen (SORC‑C), Carlton Cooke Department of Orthopedic Surgery, Copenhagen University [email protected] Hospital, Amager-Hvidovre, Copenhagen, Denmark 11 Per Holmich Aspetar Orthopaedic and Sports Medicine Hospital, Sports [email protected] Groin Pain Center, Doha, Qatar Vol.:(0123456789)1 3 Knee Surg Sports Traumatol Arthrosc new anatomical concept of the pyramidalis–anterior pubic books [4, 8, 13, 15–17, 22, 29, 33] and one cadaver study ligament–adductor longus complex (PLAC). Knowledge of in 2007 [25] which found the pyramidalis to be the only these anatomical relationships should be employed to aid abdominal muscle encountered anterior to the pubic in image interpretation and treatment planning with proxi- symphysis. mal adductor avulsions. In particular, MRI imaging should The pyramidalis muscles are paired and lie between the be employed for all proximal adductor longus avulsions to anterior surface of the rectus abdominis and the posterior assess the integrity of the PLAC. surface of the rectus sheath. The muscle exhibits a mixed fbre-type composition [18]. The function of the pyramidalis Keywords Adductor longus avulsions · Anterior pubic muscle is to tension the linea alba [8, 18] and stretch the ligament · Pyramidalis–anterior pubic ligament–adductor abdominal aponeurosis [17] to assist the rectus abdominis longus complex (PLAC) · Pyramidalis · Groin pain in so as to give greater power to the oblique and transverse athletes · Rectus abdominis · Adductor injuries · Groin muscles [4]. anatomy Adductor longus injuries are complex, and MRI inter- pretation can be difcult. The aim of the study is to sys- tematically investigate and describe the anatomy anterior to Introduction the pubic symphysis and pubic bones with special focus on the pyramidalis muscle and its anatomical connections with The symphyseal and perisymphyseal area has become of adductor longus and rectus abdominis, to elucidate injury increasing interest for hip surgeons, sports physicians and patterns occurring with adductor avulsions. radiologists dealing with hip impingement and complex pain The pyramidalis muscle is the only muscle lying anterior syndromes of the inguinal/adductor and lower abdominal to the pubic symphysis and pubic bones. The pyramidalis area. An anatomical explanation has been sought for ingui- muscle has a strong direct anatomical connection with the nal, adductor related and pubic pain experienced by athletes adductor longus. There is no signifcant connection between [32]. the rectus abdominis and the adductor longus. Several anatomy studies have been performed to examine the adductor tendons [11, 30, 31] and the connection with the distal rectus sheath [23, 25, 27]. Some studies suggest Materials and methods that a direct anatomical connection exists between the cau- dal rectus abdominis muscle and the proximal origin of the Dissection technique and observations adductor longus [6, 14, 19, 20, 34]. It has been the frst author’s clinical observation that ath- Two orthopaedic surgeons (ES, SB) with a vast experience letes with traumatic adductor longus avulsions often pre- in athletic groin injuries worked jointly to systematically sent with associated unilateral abdominal pain and lower dissect the anterior pubic soft tissues in seven fresh-frozen abdominal haematomas. When examined on MRI scans or cadaveric male pelvises [median age 67 years (60–79)]. intraoperatively, it is the frst author’s experience that in Standard surgical dissection techniques were used to per- such patients, it is the pyramidalis muscle, and not the rec- form a meticulous layer-by-layer dissection from the skin tus abdominis, that remains attached to the adductor longus down to the anterior pubic bone with macroscopic fndings preventing caudal and lateral retraction. discussed and reported. All specimens dissected included If correct, this fnding demonstrates that there is a direct the pelvis to mid-diaphyseal femur. The skin and subcuta- anatomical connection between the pyramidalis muscle and neous fat were excised from the level of anterior superior the adductor longus muscle, suggesting that the role of the iliac spines (ASIS) to mid-thigh exposing the anterior rec- pyramidalis in this type of injury may have been underes- tus sheath, external oblique fascia and fascia lata. Care was timated. The involvement of the pyramidalis in groin pain taken to preserve the integrity of the fbres of the individual or pubic-related pain in athletes has not previously been fascial plains. The linea alba was inspected for anatomical reported. Indeed, in a study reviewing 347 abdominal mus- variation (i.e. fat or cord-like). cle strains in professional baseball, no injuries to the pyrami- The fbre orientation of the anterior rectus sheath, exter- dalis were reported [7]. nal oblique fascia, anterior pubic ligament and fascia lata There are conficting views in the literature with regard was noted, with a window subsequently made in the anterior to the anatomical position of the rectus abdominis: several rectus fascia adjacent to the linea alba, allowing access to imaging and anatomy studies [6, 11, 20] reported the rec- the deeper fascia anterior to the pyramidalis muscle. The tus abdominis muscle to lie anterior to the pubic symphy- fbre orientation of this fascia was also recorded, with all sis. This description lies in direct contrast to the fndings such fascial fbre orientations noted based on orientation in of numerous eighteenth- and nineteenth-century anatomy a frontal plane. 1 3 Knee Surg Sports Traumatol Arthrosc The fascia was then completely excised from the level of signifcant. The rationale was to assess symmetry of the ASIS to mid-thigh fully exposing the pyramidalis muscle muscle. from superior to inferior, rectus abdominis, adductor lon- gus and pectineus. For each specimen, it was noted if the pyramidalis muscle was present or absent, unilateral or bilat- eral. The dimensions of the pyramidalis muscle were then Results measured using an electronic calliper KD Tools 3756: the width of the base of the muscle and the height [top to cen- Cadaveric dissection tre of the base (bissectrice)]. The distances were measured in centimetres, and each measurement was repeated three The following anatomical descriptions apply to our fnd- times. Averages were calculated for the measurements for ings in all specimens; when variations between the speci- each individual specimen. Subsequently, the average of the mens are observed, this will be mentioned separately. individual averages is calculated to determine mean values for the study group. The
Load more

Recommended publications
  • Anterior Abdominal Wall (Continue)
    Anterior rami (T7 – L1) . T7-T11 called intercostal nerves. T12 called subcostal nerve. L1 through lumber plexus i.e. ilio inguinal & ilio hypogastric nerves T7……. Epigastrum T10……Umblicus L1…Above inguinal ligament & symphysis pubis. Arterial: Upper mid line: superior epigastric artery (internal thoracic artery). Lower mid line: inferior epigastric artery (external iliac artery). Flanks: supplied by branches from intercostal artery, lumbar artery & deep circumflex iliac artery. Venous: all venous blood collected into a plexus of veins that radiate from umbilicus toward: : Above : to lateral thoracic vein then to axillary vein. Below : to superficial epigastric & greater saphenous veins then to femoral vein. Lymphatic Of Anterior abdominal Wall: Above umbilicus : drain into anterior axillary lymph nodes. Below umbilicus: drain in to superficial inguinal nodes 1)External oblique muscle. 2) Internal oblique muscle. 3) Transversus abdominis 4)Rectus abdominis. 5) Pyramidalis. Origin: The outer surface of lower 8 ribs then directed forward & downward to its insertion. Upper four slip interdigitate with seratus anterior muscle. Lower four slip interdigitate with latissimus dorsi muscle . Insertions: As a flat aponeurosis into: * Xiphoid process. * Linea alba * Pubic crest. * Pubic tubercle. * Anterior half of iliac crest . Internal Oblique Muscle: Origin : * Lumber fascia * Anterior 2/3 of iliac crest. * Lateral 2/3 of inguinal ligament. Insertion: The fibers passes upward & foreword & inserted to lower 3 ribs & their costal cartilages, xiphoid process, linea alba & symphysis pubis. Conjoint Tendon: Form from lower tendon of internal oblique joined to similar tendon from transversus abdominis . Its is attached medially to linea alba ,pubic crest & pectineal line but has a lateral free border. The spermatic cord, as it passes below this muscle, it gains a muscular cover called " Cremaster muscle " which composed of muscle & fascia.
    [Show full text]
  • University Microfilms 300 North 2Eeb Road Ann Arbor, Michigan 48106
    INFORMATION TO USERS This dissertation was produced from a microfilm copy of the original document. While the most advanced technological means to photograph and reproduce this document have been used, the quality is heavily dependent upon the quality of the original submitted. The following explanation of techniques is provided to help you understand markings or patterns ...tch may appear on this reproduction. 1. The sign or "target" for pages apparently lacking from the document photographed is "Missing Page(s)''. If it was possible to obtain the missing page(s) or section, they are spliced into the film along with adjacent pages. This may have necessitated cutting thru an image and duplicating adjacent pages to insure you complete continuity. 2. When an image on the film is obliterated with a large round black mark, it is an indication that the photographer suspected that the copy may have moved during exposure and thus cause a blurred image. You will find a good image of the page in the adjacent frame. 3. When a map, drawing or chart, etc., was part of the material being photographed the photographer followed a definite method in "sectioning" the material. It is customary to begin photoing at the upper left hand corner of a large sheet and to continue photoing from left to right in equal sections with a small overlap. If necessary, sectioning is continued again — beginning below the first row and continuing on until complete. 4. The majority of users indicate that the textual content is of greatest value, however, a somewhat higher quality reproduction could be made from "photographs" if essential to the understanding of the dissertation.
    [Show full text]
  • Transabdominal Extraperitoneal Section of the Obturator Nerve Trunk Paul H
    TRANSABDOMINAL EXTRAPERITONEAL SECTION OF THE OBTURATOR NERVE TRUNK PAUL H. HARMON, M.D. Department of Orthopedic Surgery, Permanente Hospitals and The Permanente Foundation, Oakland, California (Received for publication September 8, 1949) POPULAR method of interrupting section of the obturator nerve is to section its many peripheral branches high in the medial thigh as A originally described by Stoffel 6,7 in 1910. However, obturator nerve section in the thigh is frequently not as effective as section of the trunk higher because of accessory obturator nerves and branches of the main obturator trunk which may originate within the abdomen and pursue a variable peripheral course. Selig4'~ in 1913 and 1914 reported an anatomical study demonstrating the possibility of low intrapelvic extraperitoneal section of the obturator trunk. A number of authors (reviewed by Chandler and Seidler2 and by Wis- chnewsky s) have reported on the use of this technique. Chandler and Seidler2 reported 84 eases in 1939, in which the nerve was approached through a lower abdominal incision, just lateral to the lower border of the rectus muscle. In cases of bilateral section of the nerve these authors made a trans- verse skin incision with vertical deep dissection on the lateral side of each rectus abdominis muscle. Bonne0 described a lateral iliolumbar approach through which the obturator nerve was located high beneath the iliopsoas muscle. The disadvantage of this technique is the lengthy incision and deep dissection. Recently, Freeman 3 reported the combined section of the obtu- rator and femoral nerves in paraplegics, through a single vertical incision which crossed Poupart's ligament.
    [Show full text]
  • The Pyramidalis–Anterior Pubic Ligament–Adductor Longus Complex (PLAC) and Its Role with Adductor Injuries: a New Anatomical Concept
    The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries a new anatomical concept Schilders, Ernest; Bharam, Srino; Golan, Elan; Dimitrakopoulou, Alexandra; Mitchell, Adam; Spaepen, Mattias; Beggs, Clive; Cooke, Carlton; Holmich, Per Published in: Knee Surgery, Sports Traumatology, Arthroscopy DOI: 10.1007/s00167-017-4688-2 Publication date: 2017 Document version Publisher's PDF, also known as Version of record Document license: CC BY Citation for published version (APA): Schilders, E., Bharam, S., Golan, E., Dimitrakopoulou, A., Mitchell, A., Spaepen, M., Beggs, C., Cooke, C., & Holmich, P. (2017). The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept. Knee Surgery, Sports Traumatology, Arthroscopy, 25(12), 3969- 3977. https://doi.org/10.1007/s00167-017-4688-2 Download date: 03. okt.. 2021 Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-017-4688-2 HIP The pyramidalis–anterior pubic ligament–adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept Ernest Schilders1,2,3 · Srino Bharam3,4 · Elan Golan5 · Alexandra Dimitrakopoulou2,6 · Adam Mitchell7 · Mattias Spaepen8 · Clive Beggs2 · Carlton Cooke9 · Per Holmich10,11 Received: 29 April 2017 / Accepted: 16 August 2017 © The Author(s) 2017. This article is an open access publication Abstract Results The pyramidalis is the only abdominal muscle Purpose Adductor longus injuries are complex. The anterior to the pubic bone and was found bilaterally in all confict between views in the recent literature and various specimens. It arises from the pubic crest and anterior pubic nineteenth-century anatomy books regarding symphyseal ligament and attaches to the linea alba on the medial border.
    [Show full text]
  • Anatomy of Abdominal Incisions
    ANATOMY FOR THE MRCS but is time-consuming. A lower midline incision is needed for an Anatomy of abdominal emergency Caesarean section (where minutes may be crucial for baby and mother). The surgeon must also be sure of the pathol- incisions ogy before performing this approach. Close the Pfannenstiel and start again with a lower midline if the ‘pelvic mass’ proves to be Harold Ellis a carcinoma of the sigmoid colon! There are more than one dozen abdominal incisions quoted in surgical textbooks, but the ones in common use today (and which the candidate must know in detail) are discussed below. The midline incision (Figures 1–4) Opening the abdomen is the essential preliminary to the per- formance of a laparotomy. A correctly performed abdominal The midline abdominal incision has many advantages because it: exposure is based on sound anatomical knowledge, hence it is a • is very quick to perform common question in the Operative Surgery section of the MRCS • is relatively easy to close examination. • is virtually bloodless (no muscles are cut or nerves divided). • affords excellent access to the abdominal cavity and retroperi- toneal structures Incisions • can be extended from the xiphoid to the pubic symphysis. Essential features If closure is performed using the mass closure technique, pros- The surgeon needs ready and direct access to the organ requir- pective randomized clinical trials have shown no difference in ing investigation and treatment, so the incision must provide the incidence of wound dehiscence or incisional hernia com- sufficient room for the procedure to be performed. The incision pared with transverse or paramedian incisions.1 should (if possible): The upper midline incision is placed exactly in the midline • be capable of easy extension (to allow for any enlargement of and extends from the tip of the xiphoid to about 1 cm above the scope of the operation) the umbilicus.
    [Show full text]
  • Divarication of Rectus Abdominis Muscle Postpartum Information And
    Divarication of rectus abdominis muscle éçëíé~êíìã Information and advice What is divarication and why do I have it? For some women, pregnancy can cause separation of the stomach muscles which can also be referred to as Diastasis Recti. The right and left sides of the rectus abdominis muscle (‘six pack muscle’) separate at the linea alba which connects the two sides of the muscle together. Rectus Abdominis Abdominal Separation (approximate representation) (approximate representation) It is normal in pregnancy for the stomach muscles to separate as the uterus continues to grow and push on the abdominal wall. This only becomes problematic in pregnancy when the abdominal wall is weak. The abdominal muscles are an important muscle group in supporting your back. If they remain weak after pregnancy, it can increase your risk of suffering from back pain. Diagnosis – how do I know if I have a separation? Most pregnant women will have a separation of one or two fingers width after pregnancy and this is normal. In most cases this will spontaneously recover and will not cause you any problems. However if the gap is more than two fingers width and you have a visible doming at the midline, you may have a divarication of the abdominis muscle and would benefit from seeing a physiotherapist. You can measure this yourself by lying with your knees bent and using your fingers as a guide at the level of your belly button. What can I do to help myself? Try to avoid all activities which place a lot of pressure on your abdominal wall, or cause an over stretch to your stomach.
    [Show full text]
  • Anatomy and Physiology of the Abdominal Wall 0011 CHAPTER Internal Oblique Some Inferior fi Bers Form the Cremaster Muscle at the Level of the Inguinal Canal
    Handbook of Complex Abdominal Wall Anatomy and physiology of the abdominal wall 0011 CHAPTER Álvaro Robín Valle de Lersundi, MD, PhD Arturo Cruz Cidoncha, MD, PhD 11.1..1. Anatomy of the abdominal wall 1.1.1. Introduction The abdominal wall is delimited by muscle structures than can be classifi ed in 5 ana- tomical areas: lateral, anterior, posterior, diaphragmatic and perineal (Table 1.1). We will describe the fi rst four due to their relevance in surgical repair of complex abdom- inal wall. These groups of muscles are enclosed by several bone structures: last ribs, chondrocostal joints, xyphoid, pelvis and costal apophysis of lumbar vertebrae. Layers of the anterior and lateral abdominal wall include skin, subcutaneous tissue, super- fi cial fascia, deep fascia, muscles, extraperitoneal fascia and peritoneum. Table 1.1. Muscular limits of the abdominal wall ∙ Quadratus lumborum POSTERIOR ∙ Psoas ∙ Iliac muscle ∙ External oblique LATERAL ∙ Internal oblique ∙ Transversus abdominis ∙ Rectus abdominis ANTERIOR ∙ Piramidalis CONTENTS SUPERIOR ∙ Diaphragm 1.1. Anatomy of the abdominal INFERIOR ∙ Perineal muscles wall 1.1.2. Muscles of the abdominal wall 1.2. Physiologyygy Muscles of the anterolateral wall Rectus abdominis The rectus abdominis (m. rectus abdominis) is a long and thick muscle that is extended from the anterolateral thorax to the pubis close to the midline (Figure 1.1). 1 Figure External oblique 1.1. Rectus abdominis The external oblique muscle (m. obliquus externus abdominis) is the most superfi cial and thickest of the three lateral abdominal wall muscles (Figure 1.2). Figure 1.2. External oblique muscle Handbook of Complex Abdominal Wall Handbook of Complex Cranially, the rectus abdominis muscles originates from 3 dig- itations that insert on the 5th-7th costal cartilages, the xyphoid process and costoxyphoid ligament.
    [Show full text]
  • Anterior Abdominal Wall
    Abdominal wall Borders of the Abdomen • Abdomen is the region of the trunk that lies between the diaphragm above and the inlet of the pelvis below • Borders Superior: Costal cartilages 7-12. Xiphoid process: • Inferior: Pubic bone and iliac crest: Level of L4. • Umbilicus: Level of IV disc L3-L4 Abdominal Quadrants Formed by two intersecting lines: Vertical & Horizontal Intersect at umbilicus. Quadrants: Upper left. Upper right. Lower left. Lower right Abdominal Regions Divided into 9 regions by two pairs of planes: 1- Vertical Planes: -Left and right lateral planes - Midclavicular planes -passes through the midpoint between the ant.sup.iliac spine and symphysis pupis 2- Horizontal Planes: -Subcostal plane - at level of L3 vertebra -Joins the lower end of costal cartilage on each side -Intertubercular plane: -- At the level of L5 vertebra - Through tubercles of iliac crests. Abdominal wall divided into:- Anterior abdominal wall Posterior abdominal wall What are the Layers of Anterior Skin Abdominal Wall Superficial Fascia - Above the umbilicus one layer - Below the umbilicus two layers . Camper's fascia - fatty superficial layer. Scarp's fascia - deep membranous layer. Deep fascia : . Thin layer of C.T covering the muscle may absent Muscular layer . External oblique muscle . Internal oblique muscle . Transverse abdominal muscle . Rectus abdominis Transversalis fascia Extraperitoneal fascia Parietal Peritoneum Superficial Fascia . Camper's fascia - fatty layer= dartos muscle in male . Scarpa's fascia - membranous layer. Attachment of scarpa’s fascia= membranous fascia INF: Fascia lata Sides: Pubic arch Post: Perineal body - Membranous layer in scrotum referred to as colle’s fascia - Rupture of penile urethra lead to extravasations of urine into(scrotum, perineum, penis &abdomen) Muscles .
    [Show full text]
  • The Changes of Rectus Abdominis Muscle Thickness According to the Angle During Active Straight Leg Raise
    Original Article pISSN 2287-7576 Phys Ther Rehabil Sci eISSN 2287-7584 2013, 2 (1), 44-48 www.jptrs.org The changes of rectus abdominis muscle thickness according to the angle during active straight leg raise Hwang Jae Leea, Kil Ho Shinb, Sung Mi Byunb, Hyeon Seo Jeongb, Ji Su Hongb, Su Ji Jeongb, Wan Hee Leeb aDepartment of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea bDepartment of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republic of Korea Objective: The purpose of this study was to investigate changes of abdominal muscles thickness according to the angle during the active straight leg raise (ASLR) in young healthy subjects. Design: Cross sectional study. Methods: Twenty-three healthy university students (13 men and 10 women) voluntary participated to the study in S University. The ASLR was performed with the subject lying supine with lower extremities straight on a standard plinth, hands resting on the chest, and elbows on the plinth. When one subject performed ASLR from each angles (30o, 45o, 60o, 90o), compared changes in the thickness of rectus abdominis muscle. Changes in muscle thickness during ASLR test were assessed with ultrasonography. All subjects were to provide enough time of rest after performed ASLR. Rectus abdominis thickness were measured using re- habilitative ultrasound image. Results: Good quality rectus abdominal muscle activation data were recorded during ASLR. The length changes of linea alba showed significantly shorter in between 0o and 30o (p＜0.05). The thickness of rectus abdominis muscle were significantly differ- ent between 0o and 30o, 0o and 45o, 0o and 60o, 0o and 90o.
    [Show full text]
  • Rectus Abdominis Flap Technique for Head and Neck Reconstruction
    OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY RECTUS ABDOMINIS FLAP FOR HEAD & NECK RECONSTRUCTION Patrik Pipkorn, Brian Nussenbaum The rectus abdominis flap is based on the Surgical anatomy deep inferior epigastric artery. It is a com- posite flap and comprises muscle, over- Rectus sheath (Figures 1-5) lying fascia and skin. It is versatile and provides a large volume of soft tissue and The rectus sheath is an aponeurosis arising is technically straightforward to raise. from the external oblique, internal oblique Many variations based on the inferior epi- and transversus abdominis muscles (Figure gastric artery, including perforator flaps, 1). It encircles the paired rectus muscles. have been described. The anterior and posterior rectus sheaths merge in the midline to form the linea alba In the head and neck it is typically used to that separates the paired rectus muscles reconstruct large oral defects, skull base (Figure 1). defects, maxillectomy defects or whenever a large volume of soft tissue is required. In the head and neck it has more recently been largely supplanted by the antero- lateral thigh free flap. Benefits of the rectus flap include • Technically straightforward and quick to harvest • Constant anatomy with anatomic varia- tions being rare • Harvesting in a supine position makes a two-team approach feasible • Provides the largest volume of soft tis- sue based on a single pedicle • Long pedicle and 2-4mm diameter Figure 1: Anterior abdominal wall artery crossectional anatomy and arcuate line • Reliable perforators that do not need to be dissected or visualised When harvesting a rectus flap, the anterior • Low donor site morbidity rectus sheath is incised vertically over the midportion of the rectus muscle, whereas Caveats include the posterior sheath is preserved.
    [Show full text]
  • Low Back & Hip Unit 4
    LOW BACK & HIP UNIT MODULE 4 1 __________________________________________________________________ Welcome to Beyond Trigger Points Seminars, Low Back and Hip Unit Module 4 on the Thoracolumbar Erector Paraspinals, Abdominals and Serratus Posterior Inferior. This is Cathy Cohen. By the end of this lesson, you will be able to identify the trigger points and the dysfunctions occurring in these very important structural muscles. Our other learning objective is to differentiate between a somatovisceral versus a viscerosomatic effect. First, let's be clear on how these muscles are named. Collectively the muscle group along the spine is referred to as the paravertebral muscles. Our book labels the superficial group as the erector spinae and the deep group as the paraspinal muscles. So again, the superficial group we'll refer to as the erector spinae and the deep group as the paraspinal muscles. When I was developing my true beginner’s status in this profession, I made a bet with a chiropractor. My perception of the relative thickness between the superficial and the deep paraspinal muscles differed from his knowing. During a camping trip in the Shenandoah Valley, Virginia, I thought I had the perfect opportunity to win my bet. A farmer had donated a pig to roast and my fellow campers agreed to let me butcher the pig’s tenderloin. Those are the muscles along the pig’s spine. Well, just as my chiropractor friend said, the long fibered superficial muscles are relatively thinner than the short fatter diagonal muscles of the deep group. I lost ten dollars that day. On page 24 of the student study guide, the actions to list for the deep thoracolumbar paraspinals are: 1.
    [Show full text]
  • Bilateral Acute Myotendinous Rupture of the Rectus Abdominis Muscle
    Central Annals of Sports Medicine and Research Case Report *Corresponding author Marieke Cottaar, Radboud Universitair Medisch Centrum, Spoedeisende hulpHuispost670, route Bilateral Acute Myotendinous 670Postbus 9101 6500 HB Nijmegen, Netherlands, Email: Submitted: 13 February 2016 Rupture of the Rectus Abdominis Accepted: 01 March 2016 Published: 03 March 2016 Muscle ISSN: 2379-0571 Copyright Marieke Cottaar1*, Stefan van Rooijen2, Denise Doomernik2 and © 2016 Cottaar et al. Edward Tan2 OPEN ACCESS 1Department of Emergency Medicine, Radboud University Medical Center, Netherlands 2Department of Trauma surgery, Radboud University Medical Center, Netherlands Keywords • Rectus abdominis muscle Abstract • Rupture • MRI Background: Rupture of the rectus abdominis muscle is a rarely seen condition. • Conservative treatment Study Design: Case report with review of the literature. Case: A 24 year old woman sustained a partial rupture of the rectus abdominis muscle after a simple workout. Methods: MEDLINE, PubMed and Cochrane databases search. Conclusion: Rupture of the rectus abdominis muscle is a rare condition which can occur after minor activity. Ultrasound (US) and Magnetic Resonance Imaging (MRI) are good diagnostic methods to identify the specific rupture side. Therapy depends on the extensiveness of the rupture. In case of intact fascia, conservative treatment is considered the best management. INTRODUCTION CASE The rectus abdominis muscle is a paired muscle group in A 24 year old woman was admitted to the Emergency the abdominal wall, separated by the linea alba in the midline. It Department (ED) with acute abdominal pain. During a routine originates at the xiphoid process and the costal cartilages of ribs V to VII; its insertion is at the pubic symphysis [1].
    [Show full text]