What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients.

BACKGROUND Reimplantation of cryoconserved autologous bone flaps is a standard procedure after decompressive craniotomies. Aseptic necrosis and resorption are the most frequent complications of this procedure. At present there is no consensus regarding the definition of the relevant extent and indication for surgical revision. The objective of this retrospective analysis was to identify the incidence of bone flap resorption and the optimal duration of follow-up. METHODS Between February 2009 and March 2012, 100 cryoconserved autologous bone flaps were reimplanted at the Department of Neurosurgery, Inselspital Bern. Three patients were not available for follow-up, and five patients died before follow-up. All patients underwent follow-up at 6 weeks and a second follow-up more than 12 months postoperatively. A clinical and CT-based score was developed for judgment of relevance and decision making for surgical revision. RESULTS Mean follow-up period was 21.6 months postoperatively (range: 12 to 47 months); 48.9 % (45/92) of patients showed no signs of bone flap resorption, 20.7 % (19/92) showed minor resorption with no need for surgical revision, and 30.4 % (28/92) showed major resorption (in 4 % of these the bone flap was unstable or collapsed). CONCLUSIONS Aseptic necrosis and resorption of reimplanted autologous bone flaps occurred more frequently in our series of patients than in most reports in the literature. Most cases were identified between 6 and 12 months postoperatively. Clinical observation or CT scans of patients with autologous bone flaps are recommended for at least 12 months. Patient-specific implants may be preferable to autologous bone flaps.

De vulneribus abdominis cum intestinorum laesione et utrum sutura instituenda in eis sit? [Manuscrito] /

Acompaña nota del bibliotecario reseñando los libros solicitados para la redacción de esta memoria.

De vulneribus abdominis cum intestinorum laesione, et utrum sutura instituenda sit [Manuscrito] /

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Riverii renovati, sive Praxeos medicae methodo riverianae ... pars prima : morbos abdominis omnes pertractans /

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Friderici Hoffmanni ... Consultationum et responsorum medicinalium centuriae tres : quarum prima complectitur morbos capitis, & pectoris; secunda morbos abdominis; & morbos artuum externorum tertia.

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Differential activity of regions of transversus abdominis during trunk rotation

The role of the abdominal muscles in trunk rotation is not comprehensively understood. This study investigated the electromyographic (EMG) activity of anatomically distinct regions of the abdominal muscles during trunk rotation in six subjects with no history of spinal pain. Fine-wire electrodes were inserted into the right abdominal wall; upper region of transversus abdominis (TrA), middle region of TrA, obliquus internus abdominis (OI) and obliquus externus abdominis (OE), and lower region of TrA and OI. Surface electrodes were placed over right rectus abdominis (RA). Subjects performed trunk rotation to the left and right in sitting by rotating their pelvis relative to a fixed thorax. EMG activity was recorded in relaxed supine and sitting, and during an isometric hold at end range. TrA was consistently active during trunk rotation, with the recruitment patterns of the upper fascicles opposite to that of the middle and lower fascicles. During left rotation, there was greater activity of the lower and middle regions of contralateral TrA and the lower region of contralateral OI. The upper region of ipsilateral TrA and OE were predominately active during right rotation. In contrast, there was no difference in activity of RA and middle OI between directions (although middle OI was different between directions for all but one subject). This study indicates that TrA is active during trunk rotation, but this activity varies between muscle regions. These normative data will assist in understanding the role of TrA in lumbopelvic control and movement, and the effect of spinal pain on abdominal muscle recruitment.

Regional morphology of the transversus abdominis and obliquus internus and externus abdominis muscles

Background. The mechanisms by which the abdominal muscles move and control the lumbosacral spine are not clearly understood. Descriptions of abdominal morphology are also conflicting and the regional anatomy of these muscles has not been comprehensively examined. The aim of this study was to investigate the morphology of regions of transversus abdominis and obliquus internus and externus abdominis. Methods. Anterior and posterolateral abdominal walls were dissected bilaterally in 26 embalmed human cadavers. The orientation, thickness and length of the upper, middle and lower fascicles of transversus abdominis and obliquus internus abdominis, and the upper and middle fascicles of obliquus externus abdominis were measured. Findings. Differences in fascicle orientation, thickness and length were documented between the abdominal muscles and between regions of each muscle. The fascicles of transversus abdominis were horizontal in the upper region, with increasing inferomedial orientation in the middle and lower regions. The upper and middle fascicles of obliquus internus abdominis were oriented superomedially and the lower fascicles inferomedially. The mean vertical dimension of transversus abdominis that attaches to the lumbar spine via the thoracolumbar fascia was 5.2 (SD 2.1) cm. Intramuscular septa were observed between regions of transversus abdominis, and obliquus internus abdominis could be separated into two distinct layers in the lower and middle regions. Interpretation. This study provides quantitative data of morphological differences between regions of the abdominal muscles, which suggest variation in function between muscle regions. Precise understanding of abdominal muscle anatomy is required for incorporation of these muscles into biomechanical models. Furthermore, regional variation in their morphology may reflect differences in function. (C) 2004 Elsevier Ltd. All rights reserved.

An MRI investigation into the function of the transversus abdominis muscle during "drawing-in" of the abdominal wall

Study Design. An operator blinded dual modality trial of measurement of the abdominal muscles during drawing-in of the abdominal wall. Objectives. 1) To investigate, using magnetic resonance imaging (MRI), the function of the transversus abdominis muscle bilaterally during a drawing-in of the abdominal wall. 2) To validate the use of real-time ultrasound imaging as a measure of the deep abdominal muscle during a drawing-in of the abdominal wall. Summary of Background Data. Previous research has implicated the deep abdominal muscle, transversus abdominis, in the support and protection of the spine and provided evidence that training this muscle is important in the rehabilitation of low back pain. One of the most important actions of the transversus abdominis is to draw-in the abdominal wall, and this action has been shown to stiffen the sacroiliac joints. It is hypothesized that in response to a draw in, the transversus abdominis muscle forms a deep musculofascial corset and that MRI could be used to view this corset and verify its mechanism of action on the lumbopelvic region. Methods. Thirteen healthy asymptomatic male elite cricket players aged 21.3 +/- 2.1 years were imaged using MRI and ultrasound imaging as they drew in their abdominal walls. Measurements of the thickness of the transversus abdominis and internal oblique muscles and the slide of the anterior abdominal fascia were measured using both MRI and ultrasound. Measurement of the whole abdominal cross-sectional area (CSA) was conducted using MRI. Results. Results of the MRI demonstrated that, as a result of draw-in, there was a significant increase in thickness of the transversus abdominis (P < 0.001) and the internal oblique muscles (P < 0.001). There was a significant decrease in the CSA of the trunk (P < 0.001). The mean slide ( +/- SD) of the anterior abdominal fascia was 1.54 +/- 0.38 cm for the left side and 1.48 +/- 0.35 cm for the right side. Ultrasound measurements of muscle thickness of both transversus abdominis and the internal oblique, as well as fascial slide, correlated with measures obtained using MRI (interclass correlations from 0.78 to 0.95). Conclusions. The MRI results demonstrated that during a drawing-in action, the transversus abdominis contracts bilaterally to form a musculofascial band that appears to tighten (like a corset) and most likely improves the stabilization of the lumbopelvic region. Real-time ultrasound imaging can also be used to measure changes in the transversus abdominis during the draw-in maneuver.