• Archives of Plastic Surgery
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• 제35권6호
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• pp.663-668
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• 2008

Purpose: Pedicled transverse rectus abdominis myocutaneous(TRAM) flap has been a gold standard for breast reconstruction and one of surgical techniques preferred by many surgeons. The authors examined the course of deep epigastric artery focusing on distance from margins of rectus abdominis to pedicle and location of choke vessels to get minimal muscles during pedicled TRAM flap operation. Methods: Eleven rectus abdominis muscle from nine cadavers were used in this study. Rectus abdominis was separated from the cadavers, deep inferior and superior epigastric artery were isolated and then 8 anatomical landmarks in medial and lateral margins of rectus abdominis were designated. Distance to a pedicle meeting first horizontally was measured and vertical location from umbilicus to choke vessel was determined. In addition, 32 rectus abdominis images of 16 women(average age: 37.2 years old) from 64 channel abdomen dynamic computerized tomography were also examined with the same anatomical landmarks with those of cadavers. Results: Average distance from four landmarks on lateral margin of rectus abdominis to pedicle was 1.9 - 3.4cm and 1.8 - 3.8 cm on medial margin. Choke vessel was located between middle and inferior tendinous intersection in all cases and average distance between two tendinous intersection was 6.7 - 7.0 cm on medial margin and 6.2 cm on lateral margin. Location of inferior tendinous intersection was on umbilicus or superior of it in all cases and its average distance from umbilicus was 1.8 - 5.6 cm on medial margin and 2.7 - 6.2 cm on lateral margin. Conclusion: Distance from medial and lateral margins of rectus abdominis muscle to pedicle was the shortest in inferior tendinous intersection and that was averagely 1.8 cm on medial margin and 1.9 cm in average on lateral margin. All choke vessels were located between middle and inferior tendinous intersection.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.510-513
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• 2006

Purpose: The Rectus abdominis muscle free flap is utilized in various reconstruction surgeries due to easiness in harvesting, consistency of vascular pedicle and reduced donor site morbidity. But rarely, femoral nerve injury during rectus abdominis harvesting can be resulted. We report a case of femoral nerve injury after rectus muscle harvesting and discuss the injury mechanism with the follow-up process of this injury. Methods: To reconstruct the defect of middle cranial base after wide excision of cystic adenocarcinoma of the external ear, rectus muscle free flap was havested in usual manner. To achieve a long vessel, inferior epigastric artery was dissected to the dividing portion of femoral artery and cut. Results: One week after the surgery, the patient noted sensory decrease in the lower leg, weakness in muscle strength, and disabilities in extension of the knee joint resulting in immobilization. EMG and NCV results showed no response on stimulation of the femoral nerve of the left leg, due to the defects in femoral nerve superior to the inguinal ligament. With routine neurologic evaluations and physical therapy, on the 75th day after the operation, the patient showed improvement in pain, sensation and muscle strength, and was able to move with walking frame. In 6 months after the operation, recovery of the muscle strength of the knee joint was observed with normal flexion and extension movements. Conclusion: Rarely, during dissection of the inferior epigastric artery, injuries to the femoral nerve can be resulted, probably due to excessive traction or pressure from the blade of the traction device. Therefore, femoral nerve injury can be prevented by avoiding excessive traction during surgery.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.92-98
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• 1996

The rectus abdominis myocutaneous flap is frequently used in the field of plastic and reconstructive surgery such as breast reconstruction and as a donor of free tissue transfer. Major problems with this flap is bulkiness, the possibility of postoperative abdominal herniation and muscle weakness following the removal of the rectus abdominis muscle. We used paraumbilical perforator based skin flap fed by a muscle perforator from the deep inferior epigastric artery, with no or little muscle and fatty tissue, in three patients for the resurfacing of relatively wide and thin defects. This technique has all of the advantages of the conventional rectus abdominis myocutaneous flap with decreased possibility of postoperative abdominal herniation or muscle weakness. Another challenging merit is possibility of skin flap thinning.

• PNF and Movement
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• 제14권1호
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• pp.1-6
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• 2016

Purpose: The purpose of this study was to analyze the effects of proprioceptive neuromuscular facilitation (PNF) patterns on electromyography (EMG) activity in the rectus abdominis, internal abdominal oblique, external abdominal oblique, and erector spinae according to position changes. Methods: Ten healthy adults volunteered to participate in the study. The subjects were required to complete exercises that followed two PNF extremity patterns, namely, an upper extremity extension-adduction-internal rotation pattern and a lower extremity flexion-adduction-external rotation pattern. The exercises were applied in the supine, side-lying, and sitting positions. Repeated measure one-way ANOVA and post-hoc Bonferroni correction were used to determine the influence of the patterns on muscle activity for each muscle, and descriptive statistics were then used to determine the local/global muscle ratios. Results: The upper extremity pattern had a significant effect on the rectus abdominis and erector spinae in the supine position, and on the internal oblique and external oblique in the sitting position (p<0.05). The median value for the internal oblique/rectus abdominis showed a high ratio of 2.05, and a high ratio of 1.01 was shown for the internal oblique/external oblique in the sitting position. The lower extremity pattern had a significant effect on the rectus abdominis in the side-lying position and on the internal oblique, external oblique, and erector spinae in the sitting position (p<0.05). The median value for the internal oblique/rectus abdominis showed a high ratio of 2.83 in the sitting position and a high ratio of 1.30 for the internal oblique/external oblique in the side-lying position. Conclusion: The PNF pattern increases local muscle activation in an unstable position. Therefore, when the pattern is used for intervention purposes, trunk stability and varied position changes should be taken into account.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.469-473
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• 2006

Purpose: The transverse rectus abdominis myocutaneous(TRAM) flap has become a reliable method for autogenous breast reconstruction. However, dissection of the tendinous intersections of rectus abdominis is technically difficult. The tendinous intersection has significant vascularity within its fascial layers raising in importance of technique in elevation. If tendinous intersections are damaged during the elevation of the rectus muscle, circulation to TRAM flap can be endangered. The purpose of this study is to evaluate the number of tendinous intersections and to predict anatomical position of the tendinous intersections. Methods: We dissected 182 consecutive TRAM flaps and measured the distance between xiphoid process and each tendinous intersection and evaluated the statistic correlation among the distance, patient's height and position of umbilicus. Results: In this study, in 30.7% of patients, two tendinous intersections were observed in one rectus abdominis muscle, in 67.7% three tendinous intersections, and in 1.6% four tendinous intersections, respectively. But there was no correlation between patient's height and the distance between xiphoid process and each tendinous intersection. Conclusion: It still remains difficult to predict the position of tendinous intersections just by topography before the dissection. Careful and meticulous dissection of the tendinous intersections is still required.

• International Journal of Internet, Broadcasting and Communication
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• 제13권1호
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• pp.143-151
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• 2021

The purpose of our study is to confirm the trend of the muscle activity of the trunk and lower limb muscles by the attack method and phase during volleyball exercise. To achieve this purpose, spike serve and spike were conducted for 9 male middle school students, and at that time, it was divided into four phase, such as run jump, take off, impact, and follow, and the rectus abdominis, erector spine, and left rectus femoris, left biceps femoris, left anterior tibialis, left gastrocnemius midialis, right rectus femoris, right biceps femoris, right anterior tibialis, right gastrocnemius midialis, were examined. Spike serve and spike were each performed three times, and randomly cross-allocated to extract accurate data. We was no difference in all muscles according to the attack method, and the muscle activity of the rectus abdominis was highest in the impact phase and the muscle activity of the vertebral spine muscle was highest in the close-up phase. In addition, all of the measured left and right lower limb muscles showed the highest muscle activity between the assisted devices. As a result, We found out that regardless of the method of spike serve and spike, the lower limbs in the run-up phase for a high jump, the vertebrae in the take off phase, the preparation phase for hitting the ball strongly, and in the impact phase at the moment of hitting the ball. It can be seen that it exerts the greatest power in the rectus abdominis.

• 한국전문물리치료학회지
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• 제28권4호
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• pp.273-279
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• 2021

Background: Lunge exercises are lower extremity rehabilitation and strengthening exercises for patients and athletes. Most studies have shown the effectiveness of the forward and backward lunge exercises for treating patellofemoral pain and anterior cruciate ligament injuries (by increasing lower extremity muscle activity) and improving kinematics. Objects: However, it is not known how the two different lunge movements affect trunk muscle activities in healthy individuals. The purpose of this study was to investigate the electromyographic activity of the rectus abdominis and erector spinae muscles during forward and backward lunge exercises in healthy participants. Methods: Twelve healthy participants were recruited. Electromyographic activity of the rectus abdominis and erector spinae was recorded using surface electrodes during forward and backward lunges, and subsequently normalized to the respective reference voluntary isometric contractions of each muscle. Results: Activity of the erector spinae was significantly higher than that of the rectus abdominis during all stages of the backward lunge (p < 0.05). The activity of the erector spinae was significantly greater during the backward than forward lunge at all stages (p < 0.05). Conclusion: Backward lunging is better able to enhance trunk motor control and activate the erector spinae muscles.

• 대한물리치료과학회지
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• 제19권2호
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• pp.1-7
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• 2012

Purpose : The purpose of this study was to investigate the effect of different heel height on the electromyographic (EMG) activity in Rectus abdominis (RA) and Erector spinae (ES) during gait activity. Methods : A repeated measures design was used. 33 healthy females carried out a standardized gait activity under 3 conditions; with heel wedges of 1, 7, and 12cm in height. EMG activity was recorded from RA and ES during the activity. Data was analysed using the repeated one-way ANOVA. Results : First, as the shoe-heel height was getting higher, change of muscle activation indicated the statistically significant difference in rectus abdominis(p<0.05). Second, as the shoe-heel height was getting higher, change of muscle activation indicated the statistically significant difference in erector spinae(p<0.05). Conclusion : We found that as heel height increased, there was an increase in EMG activity in both RA and ES. This indicated that no RA : ES imbalance was elicited. This study provides information that will inform future research on how heel height affects muscle activity around the trunk.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권5호
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• pp.367-375
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• 2012

Midfacial reconstruction following resection of extensive malignant oral cavity tumors constitutes a challenging problems for reconstructive surgeons. Rectus abdominis muscle free flap (RAMFF) can be considered as the optimal reconstructive option in this case, because this flap has some advantages including consistent deep inferior epigastric artery anatomy, easy to dissect with well defined skin boundaries, acceptable donor site morbidity and the ability to perform simultaneous flap harvest with oral cancer ablation surgery. The rectus abdominis muscle forms an important part of the anterior abdominal wall and flexes the vertebral column, which is a long strap-like muscle divided transversely by three tendinous intersections, fibrous bands which are adherent to the anterior rectus sheath, which is thickly enclosed by the rectus sheath, except for the posterior part below the arcuate line that is usually located midway between the umbilicus and symphysis pubis. Below the arcuate line, this muscle lies in direct contact with the transversalis fascia and parietal peritoneum. For the better understanding of RAMFF as a routine reconstructive procedure in oral and maxillofacial surgery, the constant anatomical findings muse be learned and memorized by the young doctors in the course of the special curriculum periods for the Korean national board of oral and maxillofacial surgery. This review article will discuss the anatomical basis of RAMFF with Korean language.

• The Journal of Korean Physical Therapy
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• 제32권2호
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• pp.94-100
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• 2020

Purpose: This study examined the effects of the abdominal hollowing technique applied during plank exercises at different shoulder angles between the ground and the humerus on the abdominal muscle activity Methods: The subjects were 36 male volunteers. They were randomized to perform plank exercises or plank exercises using the hollowing technique at 80˚, 90˚, 100˚, and 110˚ between the ground and the humerus. The abdominis muscles were measured using a surface electromyogram. Independent t-tests examined the changes in the activity of these muscles according to the two exercise methods at each angle. The changes in muscle activity were examined according to the selected angles by one-way analysis of variance. Results: The activity of abdominal muscles was investigated according to the angle between the ground and the humerus during the plank exercise. As a result, the muscle activity increased significantly with decreasing angle in the rectus abdominis, external oblique, and internal oblique·transverse abdominis muscles (p<0.05). In terms of the changes in abdominal muscle activity after hollowing plank exercises at the given angles between the ground and the humerus, an increase in angle resulted in a statistically significant increase in the rectus abdominis muscle activity (p<0.05). The activities of the rectus abdominis, external oblique, and internal oblique/transverse abdominis muscles after hollowing plank exercises showed statistically significant increases (p<0.05) compared to those after plank exercises. Conclusion: The hollowing technique and the increase in the angle between the ground and the humerus may be an effective exercise method for increasing the muscle activity of the abdominis muscles.