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PURPOSE: We present a technique for covering large midline loss of abdominal wall using a novel method by autologous tissues. METHODS: Twenty-two patients (body mass index = 35,6 ± 6,9 kg/m2) were involved in the prospective cohort study. Acute and elective cases were included. The gap area was 450.1 ± 54 cm2. The average width of the midline gap was 16,3 ± 3,2 cm. The rectus muscles were mobilized from its posterior sheath. Both muscles were turned by180º medially, so that the complete abdominal wall gap could be covered without considerable tension. Changes in intra-abdominal pressure, quality of life and hernia recurrency were determined. RESULTS: There was no significant increase in the intra-abdominal pressure. Wound infection and seroma occurred in four cases. Bleeding occurred in one case. Pre- and post-operative quality of life index significantly improved (23 ± 13 vs. 47 ± 6; p = 0,0013). One recurrent hernia was registered. The procedure could be performed safely and yielded excellent results. The method was applied in acute cases. The intact anatomical structure of rectus muscles was essential. CONCLUSIONS: The midline reconstruction with bilateral turned-over rectus muscles provided low tension abdominal wall status, and it did not require synthetic mesh implantation.
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Pared Abdominal , Herniorrafia , Calidad de Vida , Recto del Abdomen , Humanos , Estudios Prospectivos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Pared Abdominal/cirugía , Herniorrafia/métodos , Resultado del Tratamiento , Hernia Ventral/cirugía , Anciano , Reproducibilidad de los Resultados , Hernia Abdominal/cirugíaRESUMEN
INTRODUCTION: Recent studies have related the climacteric period with changes in connective tissue elasticity that may be related to diastasis recti abdominis. Mat Pilates is a method of exercise without impact that currently has more practitioners, due to its satisfactory results. However, there are no studies that evaluate the effectiveness of mat Pilates for women with diastasis recti abdominis. OBJECTIVE: To evaluate the effectiveness of the mat Pilates program in climacteric women with diastasis recti abdominis. METHODS: This randomized single-blinded clinical trial evaluated climacteric women with diastasis recti abdominis. The participants were randomized into the experimental group, which participated in 3 weekly sessions of mat Pilates for 12 weeks for a total of 36 sessions, and the control group (without exercises). The inter-rectus distance was measured with a digital caliper. The G*Power Version 3.1.9.2. software was used for the sample calculation, and the SPSS 20.0 program was used for statistical analysis. RESULTS: The study comprised 21 women, including 10 in the control group and 11 in the experimental group, with mean ages of 54.3 ± 7.1 and 55.3 ± 6.0 years and body mass index values of 28.8 ± 5.5 kg/m2 and 29.9 ± 4.48 kg/m2, respectively. In the experimental group, reductions were observed in all the measures related to diastasis recti abdominis (p<0.05) in the supraumbilical, umbilical, and infra-umbilical regions. CONCLUSION: The mat Pilates method is effective for reducing diastasis recti abdominis in the climacteric period.
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Humanos , Femenino , Persona de Mediana Edad , Anciano , Climaterio , Salud de la Mujer , Recto del Abdomen/fisiopatología , Técnicas de Ejercicio con Movimientos , Diástasis Muscular , Estudios ProspectivosRESUMEN
PURPOSE: Literature reviews outline minimally invasive approaches for abdominal diastasis in patients without skin excess. However, few surgeons are trained in endoscopic rectus sheath plication, and no simulated training programs exist for this method. This study aimed to develop and validate a synthetic simulation model for the training of skills in this approach under the Messick validity framework. METHODS: A cross-sectional study was carried out to assess the participants' previous level of laparoscopic/endoscopic skills by a questionnaire. Participants performed an endoscopic plication on the model and their performance was evaluated by one blinded observer using the global rating scale OSATS and a procedure specific checklist (PSC) scale. A 5-level Likert survey was applied to 5 experts and 4 plastic surgeons to assess Face and Content validity. RESULTS: Fifteen non-experts and 5 experts in abdominal wall endoscopic surgery were recruited. A median OSATS score [25 (range 24-25) vs 14 (range 5-22); p < 0.05 of maximum 25 points] and a median PSC score [11 (range 10-11) vs 8 (range 3-10); p < 0.05 of maximum 11 points] was significantly higher for experts compared with nonexperts. All experts agreed or strongly agreed that the model simulates a real scenario of endoscopic plication of the rectus sheath. CONCLUSION: Our simulation model met all validation criteria outlined in the Messick framework, demonstrating its ability to differentiate between experts and non-experts based on their baseline endoscopic surgical skills. This model stands as a valuable tool for evaluating skills in endoscopic rectus sheath plication.
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Competencia Clínica , Recto del Abdomen , Entrenamiento Simulado , Humanos , Estudios Transversales , Recto del Abdomen/cirugía , Modelos Anatómicos , Endoscopía/educación , Endoscopía/métodosRESUMEN
OBJECTIVES: Core muscle injury is a debilitating condition that causes chronic groin pain in athletes, particularly common in soccer players. The condition is characterised by pain in the inguinal region and can lead to a significant number of absences from high-intensity physical activity. It is caused by repetitive overload without proper counterbalance from the abdominal muscles, hip flexors, and adductors in susceptible athletes. Surgical indications for core muscle injury consider cases where non-surgical treatments have not provided sufficient relief. The aim of this study was to assess the results of surgical intervention for core muscle injury using the technique employed by the Sports Medicine Group of (Institute of Orthopedics and Traumatology of Hospital das Clínicas - Universidade de São Paulo). The procedure involves releasing the anterior portion of the tendon of the rectus abdominis muscle near the pubic symphysis, along with proximal tenotomy of the adductor longus muscle tendon. METHODS: This study utilised a consecutive historical cohort analysis of the medical records of 45 male athletes, of which, 75.6% were professional soccer players, who underwent surgical treatment between January 1, 2002, and December 31, 2021. The participants included active athletes aged between 18 and 40 years, with a mean age of 23.9 years, and were diagnosed with myotendinous core muscle injury. These athletes experienced pain in the pubic symphysis and adductor tendon region and had previously undergone medical treatment and physical therapy for a duration of three to six months without significant improvement. RESULTS: The average time for athletes to return to sport after surgery was 135 days, with a majority of participants being soccer and futsal players. The surgical intervention yielded promising results, with a positive correlation between unilateral injuries and the time taken to return to sport. The complication rate was low, at 6.7%. Notably, the rate of symptom resolution was high, at 93.3%. Furthermore, the analysis indicated that the player's position on the field significantly influenced the discharge period, suggesting that the game position plays a role in the recovery process. CONCLUSION: The combined surgical procedure involving the release of the rectus abdominis tendon and adductor longus muscle tenotomy demonstrates favourable outcomes for athletes with core muscle injury. This study provides strong support for the effectiveness of this surgical approach in managing the condition and offers a potential path to recovery and return to sports activities. STUDY DESIGN: Cross-sectional study.
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Traumatismos en Atletas , Dolor Crónico , Humanos , Masculino , Adolescente , Adulto Joven , Adulto , Tenotomía/métodos , Recto del Abdomen/cirugía , Recto del Abdomen/lesiones , Volver al Deporte , Estudios Transversales , Traumatismos en Atletas/cirugía , Brasil , Tendones/cirugía , Dolor Crónico/cirugíaRESUMEN
BACKGROUND: In the motor rehabilitation of individuals with neurological disorders, including cerebral palsy (CP), Neurodevelopmental treatment (NDT) one of the most used approaches worldwide. OBJECTIVE: To verify muscle activation in NDT handling in individuals with severe CP using electromyography. METHODS: This was a controlled, cross-sectional, quantitative clinical trial. The individuals were evaluated using electromyography to analyze the muscular activation of the spinal erector, gluteus medius, rectus abdominis and multifidus during different NDT handling. We evaluated 59 individuals: 39 with spastic quadriparesis CP (Gross Motor Function Classification System, level IV-V) and 20 typically-developing individuals (control group). These groups were homogeneous with respect to age and gender. RESULTS: There was a significant difference in muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in the six NDT handling used in this study: side-sitting for kneeling; supine for lateral decubitus, prone position for lateral decubitus, "sitting on horseback", sitting on the roll, and proprioceptive stimulation sitting on the ball. CONCLUSION: The results show that all NDT handling analyzed in this study were effective for muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in individuals with severe spastic quadriparetic CP.
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Parálisis Cerebral , Humanos , Estudios Transversales , Electromiografía , Espasticidad Muscular , Músculo Esquelético/fisiología , Recto del AbdomenRESUMEN
Rectus sheath block is an interesting analgesic technique for umbilical hernia repair and there are some case reports where it was even used as the sole anesthetic. We describe the clinical case of a patient who required an urgent surgery for an incarcerated umbilical hernia and who was successfully managed with a bilateral rectus sheath block along with light sedation. Ultrasound-guided bilateral rectus sheath block provided anesthesia for our patient, avoiding the risks of the general and spinal anesthesia for his particular clinical situation and achieving an excellent postoperative analgesia, a fast recovery and hospital discharge without any complications.
El bloqueo de la vaina de los rectos es una técnica analgésica interesante para la reparación de la hernia umbilical y hay casos descritos donde incluso se ha usado como único anestésico. Describimos el caso clínico de un paciente que precisó reparación urgente de una hernia umbilical incarcerada y que fue manejado con éxito con un bloqueo de la vaina de los rectos bilateral junto con sedación ligera. El bloqueo ecoguiado de la vaina de los rectos bilateral aportó anestesia quirúrgica para nuestro paciente, evitando los riesgos de la anestesia general y espinal en su peculiar situación clínica y consiguió una analgesia postoperatoria excelente, una rápida recuperación y alta hospitalaria sin complicacione
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Humanos , Masculino , Anciano , Anestésicos Generales/administración & dosificación , Hernia Umbilical/cirugía , Anestesia/métodos , Bloqueo Nervioso/métodos , Recto del Abdomen/inervación , Urgencias Médicas , Hernia Umbilical/complicaciones , Hernia Umbilical/diagnóstico por imagenRESUMEN
Los defectos extensos de la pared abdominal y de la zona perineal derivados de las resecciones tumorales o posteriores a procesos infecciosos pueden ser resueltos de una manera rápida y sin la ayuda de técnicas microquirúrgicas mediante el colgajo VRAM, una herramienta reconstructiva importante que ha entrado en desuso, pero que sin lugar a dudas es una estrategia que proporciona seguridad para el cirujano plástico en los casos indicados. En nuestro trabajo se describe una serie de casos en los que se utilizó al colgajo VRAM para la reconstrucción de defectos en pared abdominal y la zona perineal; defectos amplios que fueron satisfactoriamente resueltos, en donde se denotan las ventajas que ofrece este colgajo para la resolución de problemas reconstructivos de las áreas anatómicas en cuestión.
Extensive defects of the abdominal wall and perineal area derived from tumor resections or after infectious processes can be resolved quickly and without the help of microsurgical techniques using the VRAM flap, an important reconstructive tool that an important reconstructive tool that that has gone into disuse, but without a doubt it is a strategy that provides security for the plastic surgeon in the indicated cases. In our work, a series of cases are described in which the VRAM flap was used for the reconstruction of defects in the abdominal wall and the perineal area; large defects that were satisfactorily resolved, where the advantages offered by this flap for the resolution of reconstructive problems of the anatomical areas in question are denoted.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Trasplante de Piel/métodos , Recto del Abdomen/trasplante , Procedimientos de Cirugía Plástica , Pared Abdominal/anomalías , Colgajo MiocutáneoRESUMEN
Gestational diabetes mellitus (GDM) is recognized as a "window of opportunity" for the future prediction of such complications as type 2 diabetes mellitus and pelvic floor muscle disorders, including urinary incontinence and genitourinary dysfunction. Translational studies have reported that pelvic floor muscle disorders are due to a GDM-induced-myopathy (GDiM) of the pelvic floor muscle and rectus abdominis muscle (RAM). We now describe the transcriptome profiling of the RAM obtained by Cesarean section from GDM and non-GDM women with and without pregnancy-specific urinary incontinence (PSUI). We identified 650 genes in total, and the differentially expressed genes were defined by comparing three control groups to the GDM with PSUI group (GDiM). Enrichment analysis showed that GDM with PSUI was associated with decreased gene expression related to muscle structure and muscle protein synthesis, the reduced ability of muscle fibers to ameliorate muscle damage, and the altered the maintenance and generation of energy through glycogenesis. Potential genetic muscle biomarkers were validated by RT-PCR, and their relationship to the pathophysiology of the disease was verified. These findings help elucidate the molecular mechanisms of GDiM and will promote the development of innovative interventions to prevent and treat complications such as post-GDM urinary incontinence.
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Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Enfermedades Musculares , Incontinencia Urinaria , Embarazo , Humanos , Femenino , Diabetes Gestacional/metabolismo , Recto del Abdomen/metabolismo , Cesárea/efectos adversos , Diabetes Mellitus Tipo 2/complicaciones , Transcriptoma , Incontinencia Urinaria/genética , Biomarcadores , Perfilación de la Expresión GénicaRESUMEN
BACKGROUND: Ex-vivo myography enables the assessment of muscle electrical activity response. This study explored the viability of determining the physiological responses in muscles without tendon, as rectus abdominis muscle (RAM), through ex-vivo myography to assess its potential as a diagnostic tool. RESULTS: All tested RAM samples (five different samples) show patterns of electrical activity. A positive response was observed in 100% of the programmed stimulation. RAM 3 showed greater weight (0.47 g), length (1.66 cm), and width (0.77 cm) compared to RAM 1, RAM 2, RAM 4 and RAM 5 with more sustained electrical activity over time, a higher percentage of fatigue was analyzed at half the time of the electrical activity. The order of electrical activity (Mn) was RAM 3 > RAM 5 > RAM 1 > RAM 4 > RAM 2. No electrical activity was recorded in the Sham group. CONCLUSIONS: This study shows that it is feasible to assess the physiological responses of striated muscle without tendon as RAM, obtained at C-section, under ex vivo myography. These results could be recorded, properly analyzed, and demonstrated its potential as a diagnostic tool for rectus abdominis muscle electrical activity.
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Cesárea , Recto del Abdomen , Estudios de Cohortes , Femenino , Humanos , Miografía , EmbarazoRESUMEN
The association of the diastasis of the rectus abdominis muscle and the medial pectus excavatum was reported. We have been using soft silicone block, sculpted intraoperatively, to correct pectus excavatum. The horizontal access used, 2 cm at a subxiphoid position, allows us to expose the sternum and the rectus abdominis muscles (RAMs). We report a case, male, 31 years presenting medial pectus excavatum and supraumbilical diastasis of the rectus abdominis muscle with a width of 35 mm at the costal arches, and 27 mm at 6 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches. The necessary space for the implant was dissected and the block was sculpted. The medial and superior aponeurosis borders of the RAM were incised at 6 cm from the xiphoid, and the posterior border of the RAM was released. The aponeurosis borders were brought together, promoting a medial and anterior positioning of the RAM. The inferior border of the implant was attached to the raw superior borders of the RAM. The result was considered satisfactory, and a magnetic resonance image 14 months after showed continuity of the implant and the muscles, promoting a uniform body contour. Registry: CAAE63181616.7.0000.0071.
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Tórax en Embudo , Tórax en Embudo/complicaciones , Tórax en Embudo/diagnóstico por imagen , Tórax en Embudo/cirugía , Humanos , Masculino , Prótesis e Implantes , Recto del Abdomen/diagnóstico por imagen , Recto del Abdomen/cirugía , Siliconas , Esternón/cirugíaRESUMEN
PURPOSE: Rectum sheath hematoma (RSH) is a rare and often misdiagnosed disease. We aimed to determine outcomes of patients affected by RSH and identify variables associated with the need of prompt intervention. METHODS: Patients diagnosed with RSH during the period 2012-2020 were retrospectively identified. Demographics, diagnostic, and therapeutic variables were evaluated. RSH was classified with computed tomography (CT) according to the Berna system. An artificial neural network (ANN) model including 12 variables was used to identify patients that might require a prompt endovascular or surgical treatment. RESULTS: A total of 20 patients were included for analysis; mean age was 69 (35-98) years and 14 (70%) were females. Iatrogenic injury and forceful contraction of the abdominal wall were the leading causes of RSH. Eleven (55%) patients were anticoagulated or antiaggregated. There were 3 (15%) grade 1, 5 (25%) grade 2, and 12 (60%) grade 3 RSH; 6 (30%) were treated conservatively, 10 (50%) with artery embolization, and 4 (20%) with surgery. Overall morbidity was 45% and there was no mortality in the series. According to the ANN, patients at high risk of requiring an invasive treatment were those with active extravasation on CT angiography, Berna grade III, age ≥ 65 years, hemodynamic instability, chronic use of corticosteroids, hematoma volume ≥ 1000 mL, and/or transfusion of ≥ 4 units of red blood cells. CONCLUSION: Conservative treatment might be effective in selected patients with RSH. Our artificial neural network analysis might help selecting patients who require endovascular or surgical treatment.
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Anticoagulantes , Recto del Abdomen , Anciano , Anticoagulantes/uso terapéutico , Femenino , Hemorragia Gastrointestinal , Hematoma/diagnóstico por imagen , Hematoma/cirugía , Humanos , Masculino , Redes Neurales de la Computación , Recto del Abdomen/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
INTRODUCTION: Core muscle injuries (CMI) are common in every sport. To minimize lost playing time, providers apply various nonsurgical treatments, including platelet-rich plasma, corticosteroids, ultrasound (US)-guided percutaneous tenotomy, and prolotherapy. Limited data exist with regard to their effectiveness. We chose to review a cohort of consecutive professional and collegiate athletes who sustained CMI at various points within their seasons and underwent a combination of US-guided percutaneous needle "tenotomy" and corticosteroid injections to complete the remainder of their seasons. METHODS: Twenty-five consecutive collegiate or professional athletes with CMI involving the rectus abdominis-adductor aponeurotic plate were included in this retrospective study. Athletes with concomitant symptomatic hip femoroacetabular impingement were included in the study. The primary outcome measure was whether athletes completed their seasons. Secondary measures were weeks played after the procedures (delay until surgery), need for repeat procedures, and outcomes after eventual surgery. Postoperative performance was assessed via interviews at 6 wk and 6 months postoperatively. RESULTS: Twenty-one of 25 (84%) athletes completed their seasons. On average, athletes returned to play 3 d (range, 1-9 d) after the procedures. Surgical repair was delayed a mean of 18 wk (range, 2-44 wk). Seven athletes had concomitant symptomatic femoroacetabular impingement and six underwent combined hip arthroscopy and core muscle repairs. Among 17 patients who eventually had core muscle surgery alone (no hip surgery), 82% (14 of 17) reported performing at their preinjury level at 6 wk. At 6 months, 96% of postop athletes (22 of 23) reported performing at their preinjury level. CONCLUSIONS: Temporizing CMI with US-guided percutaneous tenotomy and corticosteroid injections is effective in allowing continued sport participation among high-level athletes and does not negatively affect postoperative outcomes.
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Traumatismos Abdominales/terapia , Corticoesteroides/administración & dosificación , Antiinflamatorios/administración & dosificación , Traumatismos en Atletas/terapia , Recto del Abdomen/lesiones , Tenotomía/métodos , Ultrasonografía Intervencional/métodos , Traumatismos Abdominales/diagnóstico por imagen , Corticoesteroides/uso terapéutico , Adulto , Antiinflamatorios/uso terapéutico , Traumatismos en Atletas/diagnóstico por imagen , Rendimiento Atlético , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intramusculares , Masculino , Estudios Retrospectivos , Volver al Deporte , Tiempo de Tratamiento , Resultado del Tratamiento , Adulto JovenRESUMEN
Report the effects of photobiomodulation (PBM) and therapeutic ultrasound (TUS) on the viability of TRAM in mice. MATERIALS AND METHODS: Fifty-five mice Swiss were subjected to treatment for 5 days. Group 1, treatment was performed with the agents switched off. Groups 2 to 5 were treated with different wavelengths 660 and 830 nanometers (nm) and groups 6 to 11 with TUS of 1 and 3 MHz frequency. Macrometric analyses were performed using a specific camera and analyzed by the ImageJ® software. Thermographic analyses were performed with the Flir C2 and analyzed using the FLIR Tools software. RESULTS: Group 9 obtained 95% of viable area on the 3rd day and 85% on the 5th day, showing the effectiveness of the TUS in the flap viability. Regarding skin temperature, there was a difference only in the immediate postoperative period in group 1, which had a lower temperature than the other groups. CONCLUSIONS: TUS demonstrated greater efficiency in maintaining the viability of TRAM. PBM 830 nm also demonstrated good results in the viability of TRAM.
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Mamoplastia , Colgajo Miocutáneo , Terapia por Ultrasonido , Animales , Supervivencia de Injerto , Ratones , Modelos Teóricos , Recto del Abdomen/diagnóstico por imagen , Recto del Abdomen/cirugíaRESUMEN
INTRODUCTION: Diastasis recti abdominis (DRA) and pelvic floor dysfunction (PFD) occurs commonly with aging; however, little is known about what leads to these changes. OBJECTIVE: We aimed to investigate and compare the presence or absence of DRA and PFD in peri- and postmenopausal women. METHODS: This cross-sectional study involved 150 participants who answered questions on their sociodemographic and clinical profiles related to urinary and fecal incontinence and pelvic organ prolapse. Diastasis recti abdominis was diagnosed with a digital caliper. RESULTS: Supra-umbilical diastasis occurred in 37.3% of cases, and 78.6% of participants with DRA had PFD. No significant differences existed between participants with and without DRA in terms of background and clinical variables. However, participants with DRA were 2.6 times more likely to have PFD than participants without DRA. Furthermore, the presence of DRA was significantly shown to be a risk factor for PFD on binary logistic regression analyses (p = .01, OR = 3.2). CONCLUSIONS: This cross-sectional study suggests that DRA is a predictive factor of PFD in women aged over 50 years.
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Enfermedades Musculares , Prolapso de Órgano Pélvico , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Diafragma Pélvico , Posmenopausia , Recto del AbdomenRESUMEN
Objetivo: Avaliar a relação entre diástase músculo reto abdominal (DMRA) supra- e infraumbilical com a contração da musculatura do assoalho pélvico (MAP) de mulheres no pós-parto imediato, internadas em uma maternidade pública. Metodologia: Estudo transversal aprovado pelo Comitê de Ética em Seres Humanos (nº 1.674.698; CAA 6163616.8.0000.0096). Participaram 60 puérperas de baixo risco, assistidas nas enfermarias de uma maternidade. A DMRA foi avaliada pela palpação abdominal e graduada conforme a quantidade de polpas digitais. A contração da MAP foi avaliada por meio da inspeção visual. A correlação das variáveis foi realizada pelo teste de Spearman, com nível de significância em p<0,05. Resultados: 40 puérperas (66,7%) apresentaram DMRA supraumbilical e 23 participantes (38,4%) mantinham DMRA infraumbilical maior do que 2 polpas digitais. Cerca de 71,4% das puérperas contraíram MAP isoladamente e 12,7% contraíram MAP utilizando mecanismos compensatórios; 14,3% das puérperas não conseguiram realizar a contração. A DMRA supraumbilical está correlacionada com a contração da MAP com músculos acessórios de primíparas (p=0,03; r=-0,46); a sustentação da contração da MAP em multíparas (p=0,03; r=-0,43); e a ausência da contração da MAP (=0,03; r=0,35) e ao tempo de sustentação da contração (p=0,02; r=-0,40) em puérperas que realizaram parto vaginal. Conclusão: A presença da DMRA supraumbilical apresenta correlação com a função da MAP de puérperas de acordo com a paridade e a via de parto do último parto. (AU)
Aim: to analyze the relationship between supra- and infraumbilical diastasis recti abdominis (DRA) and pelvic floor musculature (PFM) contraction of women at immediate postpartum, admitted in a public maternity hospital. Methodology: Cross-sectional study approved by the Human Ethics Committee (nº 1.674.698; CAA 56163616.8.0000.0096). Sixty low-risk puerperal women attended at the maternity participated were included. DRA was assessed by abdominal palpation and graded according to number of digital pulps. PFM contraction was assessed by visual inspection. The correlation of variables was performed using the Spearman test, with a significance level of p <0.05. Results: 40 participants (66.7%) had supraumbilical DRA and 23 participants (38.4%) had infraumbilical DRA greater than 2 digital pulps. About 71.4% of women contract only PFM and 12.7% contract PFM using compensatory mechanisms; 14.3% of puerperal women were unable to perform a contraction. Supraumbilical DRA is correlated with PFM contraction and accessory muscles (p = 0.03; r = -0.46); to time of sustained PFM contraction in multiparous women (p = 0.03; r = -0.43); and absence of PFM contraction (= 0.03; r = 0.35) and the time of sustained PFM contraction (p = 0.02; r = -0.40) in puerperal women who underwent vaginal delivery. Conclusion: The presence of supraumbilical DRA correlates with PFM function according to the parity and the type of delivery. (AU)
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Humanos , Femenino , Embarazo , Adulto , Salud de la Mujer , Modalidades de Fisioterapia , Diafragma Pélvico , Diástasis Muscular , Palpación , Paridad , Mujeres , Recto del Abdomen , Parto , Periodo Posparto , Maternidades , MúsculosRESUMEN
BACKGROUND: Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period. OBJECTIVE: To systematically review whether abdominal and pelvic floor muscle (PFM) exercise programs are effective in the treatment of DRA postpartum. METHODS: Electronic search was conducted from inception to March 2020. Randomized controlled trials (RCT) or pilot RCTs that compared abdominal training, PFM training, or a combination of both in at least one arm of the trial were included. The primary outcome was presence of DRA (numbers/percentage) or inter-recti distance (IRD) change. GRADE was used to rate the overall quality of evidence. Pooled effect sizes were expressed as mean difference (MD) with 95% confidence intervals (CI). RESULTS: Seven RCTs totaling 381 women were included. Two studies comparing transversus abdominis (TrA) training with minimal intervention provided data to be included in a meta-analysis. The results provided very low level quality evidence that TrA training reduced IRD (MDâ¯=â¯-0.63â¯cm, 95% confidence interval: -1.25, -0.01, I2â¯=â¯0%). Two studies included curl-up exercises as part of their intervention. Level of evidence based on single trials of high risk of bias show very low evidence that curl-up training is more effective than minimal intervention for treating DRA. Similarly, analyses based on single trials provided low to very low quality evidence that PFM training is not more effective than minimal intervention for treating DRA. CONCLUSION: There is currently very low-quality scientific evidence to recommend specific exercise programs in the treatment of DRA postpartum.
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Diástasis Muscular , Diafragma Pélvico , Terapia por Ejercicio , Femenino , Humanos , Periodo Posparto , Ensayos Clínicos Controlados Aleatorios como Asunto , Recto del AbdomenRESUMEN
INTRODUCTION: Minimally invasive surgery for diastasis recti has gained attention in the recent past, with several reports with different names and particularities being suggested by the authors. SCOLA (Subcutaneous OnLay endoscopic Approach) is an example of this technique, described here in standardized technique. DESCRIPTION OF THE TECHNIQUE: Basic steps to perform the procedure are detailed, beginning with patient and surgical team positioning, including trocar placement and tips and tricks of the subcutaneous dissection, steps needed to achieve full dissection of the preaponeurotic space, diastasis recti plication, mesh positioning and fixation and drain positioning with fixation of the umbilical stalk. DISCUSSION: Regardless of different names and small technical variations, endoscopic pre-aponeurotic mesh positioning can be performed with well-established steps on a reproducible fashion, aiming to achieve better results. Careful attention should be paid to appropriate patient selection and drain placement to reduce seroma rate, the most common complication.
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Hernia Ventral , Herniorrafia , Endoscopía , Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Humanos , Recto del Abdomen/cirugía , Mallas QuirúrgicasRESUMEN
BACKGROUND: The components separation technique (CS) is used for the reconstruction of complex abdominal wall defects. Release and undermining of the rectus abdominis muscle (RAM) and external oblique muscle (EOM) decrease tension on the abdominal midline, reducing recurrence of ventral hernia, but causes major changes in the physiology of abdominal wall. The purpose of the study was to determine which muscle release and undermining produces the lowest tension on the midline. METHODS: Twenty fresh cadavers were dissected and the anterior and posterior layers of the rectus sheath were isolated in the midline. The forces necessary to advance the layers of the rectus sheath to the mid abdomen were measured bilaterally at two points located 3 cm above and 2 cm below the umbilicus, and at 3 different stages: before any muscle release; after release and undermining of the right RAM and left EOM; and after release and undermining of the left RAM and right EOM. Comparisons of tensile forces were conducted separately for the different muscles involved, layers of the rectus sheath, measurement points, and stages of separation. RESULTS: Tension on the abdominal midline after the release and undermining of both the RAM and EOM was reduced by 56% (p <0.05), 42% after the release and undermining of the EOM alone (p <0.05), and 35% after release and undermining of the RAM alone (p <0.05). CONCLUSION: Release and undermining of the EOM by CS led to lower tension on the abdominal midline compared to that associated with the release of the RAM alone.
Asunto(s)
Pared Abdominal/anatomía & histología , Pared Abdominal/cirugía , Procedimientos de Cirugía Plástica/métodos , Recto del Abdomen/cirugía , Cadáver , Estudios Transversales , Disección , Hernia Ventral/prevención & control , Hernia Ventral/cirugía , Humanos , Recurrencia , Resistencia a la TracciónRESUMEN
SUMMARY: The inferior epigastric artery (IEA) is a major blood vessel that supplies the anterior abdominal wall. The aim of the current study was to provide clinicians, surgeons, and obstetricians with sufficient anatomical data on the inferior epigastric artery, such as its origin and branching pattern. The study included 20 embalmed cadavers, these cadavers were dissected, and the inferior epigastric artery and vena comitans/venae comitantes were identified and traced downwards to the external iliac vessels. The origins, caliber, course and pedicle length of both the artery and the vein(s) were studied. The inferior epigastric artery arose independently from the distal external iliac artery deep to the inguinal ligament in 19 (95 %) cadavers. The artery entered the rectus abdominis muscle at its middle third in 13 (65 %) cases and at its lower third in the remaining specimens. In this study, we found that the artery divided into two branches in 18 (90 %) of the cases; in the remaining two cases, it continued as one trunk. The average pedicle length was 7.2 cm. The mean caliber of the IEA was 3.7 mm. In 18 (90 %) dissections, the venous drainage consisted of a pair of venae comitantes that united to form a common vessel at their draining point on the external iliac vein. The average diameter was 3.9 mm. The current study focuses on the anatomical features of the inferior epigastric artery to increase the success rate of abdominal and pelvic operations in clinical practice.
RESUMEN: La arteria epigástrica inferior (AEI) es un vaso sanguíneo principal que irriga la pared abdominal anterior. El objetivo del presente estudio fue proporcionar a los médicos, cirujanos y obstetras suficientes datos anatómicos sobre la arteria epigástrica inferior, como su origen y patrón de ramificación. El estudio incluyó 20 cadáveres embalsamados, los que se disecaron y se identificó la arteria epigástrica inferior y la vena concomitante y se siguieron hasta los vasos ilíacos externos. Se estudiaron los orígenes, calibre, trayecto y longitud del pedículo tanto de la arteria como de la (s) vena (s). La arteria epigástrica inferior surgió independientemente de la arteria ilíaca externa profunda al ligamento inguinal en 19 (95 %) cadáveres. La arteria ingresó al músculo recto del abdomen en su tercio medio en 13 (65 %) casos y en su tercio inferior en las muestras restantes. En este estudio, encontramos que la arteria se dividió en dos ramas en 18 (90 %) de los casos; en los dos casos restantes, continuó como un tronco. La longitud media del pedículo fue de 7,2 cm. El calibre medio del AEI fue de 3,7 mm. En 18 (90 %) disecciones, el drenaje venoso consistió en un par de venas concomitantes las que formaron un vaso común en su punto de drenaje en la vena ilíaca externa. El diámetro medio fue de 3,9 mm. El estudio actual se centra en las características anatómicas de la arteria epigástrica inferior con el propósito de mejorar la tasa de éxito de las cirugías abdominales y pélvicas en la práctica clínica.