Rectus abdominis muscle innervation: an anatomical study with surgical implications in diep flap harvesting
| Autor: | Cesare Tiengo, Andrea Porzionato, Anna Rambaldo, Carla Stecco, Raffaele De Caro, A. U. Behr, Veronica Macchi, Gian Paolo Azzena |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Rectus Abdominis Transplant Donor Site Pathology and Forensic Medicine Abdominal wall 03 medical and health sciences 0302 clinical medicine DIEP flap Nuclear Medicine and Imaging medicine.artery medicine Cadaver Humans Radiology Nuclear Medicine and imaging Rectus abdominis muscle Abdominal wall morbidity Rectus abdominis innervation Thoracolumbar nerves Anatomy Surgery 2734 Radiology Nuclear Medicine and Imaging Aged Vascular pedicle business.industry Deep Inferior Epigastric Artery Rectus sheath Middle Aged Plastic Surgery Procedures Epigastric Arteries eye diseases medicine.anatomical_structure Perforating arteries Close relationship 030220 oncology & carcinogenesis Female 030101 anatomy & morphology Radiology business Perforator Flap |
| Zdroj: | Surgical and radiologic anatomy : SRA. 40(8) |
| ISSN: | 1279-8517 |
| Popis: | To improve the current knowledge of rectus abdominis innervation, so as to identify a safe area where the vascular pedicle should be dissected to reduce the risk of nerve damage during deep inferior epigastric perforator (DIEP) flap harvesting. Ten abdominal wall dissections were performed. Perforating arteries were identified and classified into nerve-related perforators and non-nerve-related perforators depending on the presence of nerve branches crossing vessels. The width of rectus abdominis and the distance between perforators and lateral edge of rectus abdominis muscle were measured. In contralateral hemi-abdomen, full-thickness specimens were sampled for microscopical analysis. Nerves enter the rectus sheath piercing the lateral edge (60% of cases) or the posterolateral surface of the sheath (40% of cases). They enter the rectus abdominis muscle at a mean distance of 4.3 cm from the lateral margin of the sheath. Within rectus abdominis, nerves have a mean thickness of 200.3 µm and split into 2–4 sensitive and 2–4 muscular branches. Close relationship between muscular branches and deep inferior epigastric artery perforators were shown. The mean distance between nerve-related perforators and the lateral edge of the rectus abdominis was of 3.26 ± 0.88 cm. The mean distance between non-nerve-related perforators and the lateral edge of the rectus abdominis was of 6.26 ± 0.90 cm. To spare nerves and reduce donor-site complications, a perforator located beyond an imaginary line of 3.26 ± 0.88 cm far from the lateral edge of rectus abdominis muscle should be included in the DIEP flap. |
| Databáze: | OpenAIRE |
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