Mapping traction strength of the anterior rectus sheath in cadaver

Abstract

Purpose:The tension at the aponeurotic edges of abdominal wall defects is an important factor of dehiscence and incisional hernia formation. The purpose of this study is to map and compare the traction force necessary for medial mobilization in various levels of the anterior rectus sheath in cadavers. Methods: Twenty four adult male cadavers, raging from 22 to 59 years old, with the abdominal wall intact and without prior preservation techniques, were dissected. A complete excision of the linea alba was performed. Traction loops of 10 mm in diameter were made in the anterior rectus sheath and were placed: 2, 4, 6 and 8 cm below the lower edge of the umbilicus and 3, 6 and 9 cm above the upper edge of the umbilicus. Each loop was mobilized 10 mm in the medial direction, using an analog dynamometer. The values obtained in each level were compared using Friedman's analysis of Variance for p < 0.05. Results: The average traction values obtained at the various levels were compared and there was no statistical significant difference. Conclusion: There is no variation in tension along the whole extension of the anterior rectus sheath. Key words: Hernia, Ventral. Tensile Strength. Cadaver. RESUMO Objetivo:A tensão na margem da aponeurose de um defeito da parede abdominal é um importante fator de deiscência e formação da hérnia incisional. O objetivo deste estudo é mapear e comparar a força de tração necessária à mobilização medial em vários níveis da lâmina anterior do músculo reto do abdome em cadáveres. Métodos: Vinte e quatro cadáveres adultos masculinos, com idade entre 22 e 59 anos, com a parede abdominal intacta e sem técnicas prévias de conservação, foram dissecados. Uma excisão completa da linha alba foi realizada. Alças de tração de 10 mm de diâmetro foram realizadas na lamina anterior do músculo reto do abdome e estavam localizadas: 2,4,6 e 8 cm abaixo da margem inferior do umbigo e 3,6 e 9 cm da margem superior do umbigo. Cada alça foi mobilizada 10 mm em direção medial, usando um dinamômetro analógico. Os valores obtidos em cada nível foram comparados usando a analise de variância de Friedman com p < 0,05. Resultados: Os valores de tração obtidos nos vários níveis foram comparados e não apresentaram significância estatística. Conclusão: Não há variação de tensão por toda lamina anterior do músculo reto do abdome. Descritores: Hérnia Ventral. Resistência à Tração. Cadaver.

An experimental model for the study of collagen fibers in skeletal muscle

“…It also plays an important part in the transmission of forces resulting from active muscle contraction 3,5 . Collagen is an important component of muscles and fasciae that provides strength to the structures [6][7][8][9] . At present, more than 19 types of collagen have been described 10 , with the types I, II and III being the most studied ones.…”

Relaxation incisions and tensile strength in the abdominal wall of pigs

“…Silveira et al . 4 , also studied the tension along the entire anterior sheath of the rectus muscle, and found no statistically significant difference between the various points studied, which means that there was no difference in the resistance to the medial traction; therefore, there is no place in the previous sheath that can be closed with less tension. For this reason, it is important to study techniques that seek to minimize tension for the correction of major defects and adequate closure of the abdominal cavity.…”

“…Laparotomy is considered a routine procedure in medical practice, with the median incision being the main access route to the abdominal cavity, offering wide visceral exposure. This incision, if performed in the alba line, causes little blood loss; however, in the supra-umbilical region, there is a greater incidence of eviscerations and eventrations, since it is a place subject to greater tensions 1 - 4 .…”

Physiologic Tension: Technique for Measuring and Baseline Values

“…One study by Silveira and one by Amorim studied cadaveric abdominal wall tension at different points along the abdominal wall to determine if there were any variation in value. 5,6 One of the first studies to objectively measure tension on the abdominal wall in living patients was carried out by Klein et al 7 in 1996, where tension was measured at ventral hernia defects. These measurements were used to help guide which hernia operation the patient underwent.…”