Objective: To examine the preliminary effect of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis for the prevention of parastomal hernia after abdominoperineal resection for rectal cancer. Methods: This study is a prospective case series study. From June 2021 to June 2022, patients with low rectal cancer underwent laparoscopic abdominoperineal resection combined with extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis at the First Department of General Surgery, Shaanxi Provincial People's Hospital were enrolled. The clinical data and postoperative CT images of patients were collected to analyze the incidence of surgical complication and parastomal hernia. Results: Totally 6 cases of patient were enrolled, including 3 males and 3 females, aging 72.5 (19.5) years (M(IQR)) (range: 55 to 79 years). The operation time was 250 (48) minutes (range: 190 to 275 minutes), the stoma operation time was 27.5 (10.7) minutes (range: 21 to 37 minutes), the bleeding volume was 30 (35) ml (range: 15 to 80 ml). All patients were cured and discharged without surgery-related complications. The follow-up time was 136 (105) days (range: 98 to 279 days). After physical examination and abdominal CT follow-up, no parastomal hernia occurred in the 6 patients up to this article. Conclusions: A method of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis is established. Permanent stoma can be completed with this method safely. It may have a preventive effect on the occurrence of parastomal hernia, which is worthy of further study.
Male ; Female ; Humans ; Colostomy/methods* ; Rectus Abdominis ; Laparoscopy/methods* ; Incisional Hernia/surgery* ; Rectal Neoplasms/surgery* ; Hernia, Ventral/surgery* ; Surgical Mesh/adverse effects*

OBJECTIVE: To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect. METHODS: Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly. RESULTS: All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis). CONCLUSION The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.
Male ; Female ; Humans ; Adult ; Myocutaneous Flap/surgery* ; Plastic Surgery Procedures ; Thoracic Wall/surgery* ; Rectus Abdominis/transplantation* ; Skin Transplantation ; Breast Neoplasms/surgery* ; Soft Tissue Injuries/surgery* ; Treatment Outcome

Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.
Female ; Humans ; Urinary Bladder/surgery* ; Ureter/surgery* ; Rectus Abdominis ; Drainage ; Fistula

Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.
Female ; Humans ; Urinary Bladder/surgery* ; Ureter/surgery* ; Rectus Abdominis ; Drainage ; Fistula

OBJECTIVE: To investigate the therapeutic effect of lateral rectus abdominis incision combined with winged calcaneal plate on pelvic and acetabular fractures involving quadrilateral body. METHODS: From January 2017 to April 2021, 21 cases of pelvic and acetabular fractures involving quadrilateral bodies were retrospectively analyzed, including 12 males and 9 females. The age ranged from 21 to 73 years with an average of (43.23±6.45) years. All patients were treated by lateral incision of rectus abdominis combined with open reduction and internal fixation with aerofoil plate, including 12 cases of pelvis with anterior and posterior column fractures, 7 cases of acetabular fractures with quadrilateral involvement, and 2 cases of acetabular fractures with central dislocation. RESULTS: All 21 patients were followed up for 12 to 36 months with an average of (18.60±6.45) months. All fractures healed. According to Matta's image reduction evaluation after operation, 11 cases of pelvic anterior and posterior column fractures were all anatomic reduction, 1 case was satisfactory reduction, 7 cases of acetabular fractures involving quadrilateral were anatomic reduction, 1 case with central dislocation was anatomic reduction, and 1 case was satisfactory reduction. The modified Merle D'Aubigne Postel hip joint score was 13 to 17 points. CONCLUSION Lateral incision approach of rectus abdominis combined with wing-shaped steel plate can obtain good radiological and clinical results in the treatment of complex pelvic and acetabular fractures involving quadrilateral bodies, and has advantages in the treatment of complex pelvic fractures and acetabular quadrilateral fractures.
Male ; Female ; Humans ; Young Adult ; Adult ; Middle Aged ; Aged ; Rectus Abdominis ; Retrospective Studies ; Acetabulum/injuries* ; Bone Plates ; Hip Fractures/surgery* ; Spinal Fractures

Objective: To explore the method and plausibility of using free rectus abdominis flap (FRAF) to reconstruct the major and complex defects in the craniofacial regions after ablation of advanced sinonasal carcinoma. Methods: From 2007 to 2018 at No. 980 Hospital of Joint Logistic Supportive Force of People's Liberation Army of China, 13 patients with advanced carcinoma of nasal cavity and paranasal sinuses, including 11 males and 2 females, aged from 33 to 67 years, were treated with FRAF to repair the invasion of skull base, face and orbit. Based on adequate and meticulous preoperative evaluations on patients and tumors, complete resection of tumor bulks was performed. According to the sites, characters and extents of the defects, FRAF was introduced in different ways into reconstruction of major and complex defects in the craniofacial regions after resection of advanced sinonasal carcinomas, restoring the structure and contour of the craniofacial region. Results: Complete resection of tumors was achieved in all cases. For repairing the major and complex defects resulted from tumor ablation, FRAF graft was conducted in 13 patients with advanced sinonasal carcinomas. The recipient vessels were facial artery and vein in 9 cases, superficial temporal artery and vein in 4 cases. Vascular bridging with the external jugular vein was carried out in 2 cases who underwent submandibular neck dissections, in which facial artery and vein were used as recipient vessels. Free fibular flap was used along with FRAF in a case undergone bilateral maxillectomy. Pedicled galea capitis and periosteal flap were applied simultaneously in 3 cases with dura defects at the skullbase resulted from tumor resection. All flaps used in 13 cases survived uneventfully without major complications, with successful repair of defects, reconstruction of structures and restoration of contour of craniofacial regions. Conclusion: With adequate evaluation of resectability of tumors as well as nature and extent of defects after tumor removal, FRAF transplantation is an ideal method and strategy of choice for reconstructing the major and complex defects in craniofacial regions resulted from tumor ablation of advanced sinonasal carcinomas.
Carcinoma ; Female ; Humans ; Male ; Myocutaneous Flap ; Orbit ; Reconstructive Surgical Procedures ; Rectus Abdominis

PURPOSE: The creation of the nipple-areola complex is the final stage in breast reconstruction and highly affects patient satisfaction. The neo-nipple is well known to shrink over time, particularly in the nipple projection. Currently, no reconstruction technique is clearly superior in terms of nipple size maintenance. We evaluated nipple size changes among several methods of breast mound reconstruction. METHODS: Seventy-eight patients received nipple-areola complex reconstruction secondarily after breast reconstruction. C-V flap nipple reconstructions were performed using a free transverse rectus abdominis myocutaneous (TRAM) flap in 25 cases (TRAM group), a latissimus dorsi (LD) myocutaneous flap in 27 cases (LD group), and an implant in 26 cases (implant group). The circumference and projection of the neo-nipple were measured using a flexible ruler, immediately after reconstruction and average 10 months after surgery. RESULTS: The overall circumference and projection at the final measurement were 91.43% ± 7.11% and 62.16% ± 21.55%, respectively, of immediate postoperative values. The change in circumference did not significantly differ among the 3 groups. In contrast, the change in projection was significantly worse in implant group compared to that in TRAM and LD groups. In addition, among the patients in implant group, greater inflation was significantly associated with greater decrease in the nipple projection. CONCLUSION: Breast mound reconstruction with autologous musculocutaneous flap techniques achieves better long-term maintenance of the neo-nipple projection compared to that achieved with expanded tissue and implantation. Considering the prospective loss of long-term nipple dimension, the preoperative design should be oversized in accordance with its origin in mound reconstruction.
Breast* ; Female ; Humans ; Inflation, Economic ; Mammaplasty* ; Myocutaneous Flap ; Nipples* ; Patient Satisfaction ; Prospective Studies ; Reconstructive Surgical Procedures ; Rectus Abdominis ; Superficial Back Muscles

PURPOSE: The aim of this study was to investigate the changes of contraction patterns and the differences of activities in trunk muscles during dynamic balance (multidirectional tilting exercise). METHODS: Eight physically active male subjects participated in the study. Tilting exercises were included by four directions (i.e., forward, backward, left, and right side), and were undertaken at three different tilting degrees (i.e., 10°, 20°, and 30°). They performed two occasions of tilting exercise, separated by 6-week time interval. Surface electromyography system was used for record of any signals produced by muscles which normalized as percentage of maximum voluntary isometric contraction. RESULTS: There were no statistically significant different interactive effects in any of muscles between two factors (time vs. degree). However, we identified significant main effects of degrees (among 10°, 20°, and 30°) in muscle activations during maintaining with forward tilting (left and right longissimus, multifidus), backward tilting (left and right rectus abdominis, external oblique), left side tilting (right rectus abdominis, external oblique, longissimus, multifidus), right side tilting (left rectus abdominis, external oblique, longissimus, multifidus). CONCLUSION: Findings from this study allow the multidirectional tilting exercise to be considered as suitable for ameliorate muscle balance by inducing co-contraction in trunk muscles.
Electromyography ; Exercise ; Humans ; Isometric Contraction ; Male ; Muscles ; Rectus Abdominis

BACKGROUND: Serial volumetric changes of reconstructed breasts have not been studied in detail. In this study, we analyzed serial volumetric changes of reconstructed and contralateral normal breasts during long-term follow-up, with a focus on the effect of various adjuvant therapies. METHODS: Among all patients who underwent immediate breast reconstruction with a unilateral pedicled transverse rectus abdominis musculocutaneous (p-TRAM) flap, 42 patients with valid data from ≥3 postoperative positron emission tomography-computed tomography (PET-CT) scans were included. The volumes of the reconstructed and normal breasts were measured, and the ratio of flap volume to that of the contralateral breast was calculated. Serial changes in volume and the volume ratio were described, and the effects of chemotherapy, radiation therapy, and hormone therapy on volumetric changes were analyzed. RESULTS: The mean interval between the initial reconstruction and each PET-CT scan was 16.5, 30, and 51 months respectively. Thirty-five, 36, and 10 patients received chemotherapy, hormone therapy, and radiation therapy, respectively. The flap volume at each measurement was 531.0, 539.6, and 538.0 cm3, and the contralateral breast volume was 472.8, 486.4, and 500.8 cm3, respectively. The volume ratio decreased from 115.1% to 113.4%, and finally to 109.6% (P=0.02). Adjuvant therapies showed no significant effects. CONCLUSIONS: We demonstrated that the p-TRAM flap maintained its volume over a long-term follow up, while the volume of the contralateral native breast slowly increased. Moreover, adjuvant breast cancer therapies had no statistically significant effects on the volume of the reconstructed p-TRAM flaps or the contralateral native breasts.
Breast Neoplasms ; Breast ; Drug Therapy ; Electrons ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Myocutaneous Flap ; Radiotherapy ; Rectus Abdominis ; Surgery, Plastic

BACKGROUND: Topical hemostatic agents are used when ligation, electrocauterization, or other conventional hemostatic methods are impractical. Because a hemostatic agent is a foreign body, it can cause foreign body reactions, inflammation, and infections that can interfere with the wound healing process. Therefore, we should select hemostatic agents after considering their effects on wound healing. Here, we compared the effects of hemostatic agents on wound healing in a rectus abdominis muscle defect in rats. METHODS: Twelve Sprague Dawley rats were subjected to creation of a 6 × 6 mm defect in the rectus abdominis muscle and divided into four groups: control group; group A, Tachosil fibrin sealant patch; group B, Surgicel Fibrillar oxidized regenerated cellulose; and group C, Surgicel Snow oxidized regenerated cellulose. For the histologic analysis, biopsies were performed on the 3rd, 7th, and 27th days. RESULTS: The foreign body reaction was the weakest in group A and most significant in group C. The inflammatory cell infiltration was the weakest in group A and similar in groups B and C. Muscle regeneration differed among periods. The rats in group A were the most active initially, while those in group C showed prolonged activity. CONCLUSION: Tachosil and Surgicel administration increased inflammation via foreign body reactions, but the overall wound healing process was not significantly affected. The increased inflammation in the Surgicel groups was due to a low pH. We recommend using Tachosil, because it results in less intense foreign body reactions than Surgicel and faster wound healing due to the fibrin action.
Animals ; Biopsy ; Cellulose ; Cellulose, Oxidized ; Fibrin Tissue Adhesive ; Fibrin ; Fibrinogen ; Foreign Bodies ; Foreign-Body Reaction ; Hemostatics ; Hydrogen-Ion Concentration ; Inflammation ; Ligation ; Rats ; Rats, Sprague-Dawley ; Rectus Abdominis ; Regeneration ; Snow ; Thrombin ; Wound Healing ; Wounds and Injuries