Arch Plast Surg.  2013 Jul;40(4):359-366. 10.5999/aps.2013.40.4.359.

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

• Jeong W
• Son D
• Yeo H
• Jeong H
• Kim J
• Han K
• Lee S

• KMID: 2167888
• DOI: http://doi.org/10.5999/aps.2013.40.4.359

Abstract

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.

Keyword

Rectus abdominis; Nerve transfer; Electromyography; Multidetector computed tomography

MeSH Terms

Electromyography
Humans
Intercostal Nerves
Multidetector Computed Tomography
Muscles
Muscular Atrophy
Nerve Transfer
Rectus Abdominis
Reference Values
Regeneration
Research Personnel
Retrospective Studies