title: Anatomical and functional recovery of neurotized remnant rectus abdominis muscle in muscle-sparing pedicled transverse rectus abdominis musculocutaneous flap.
abstract: BACKGROUND
  Pedicled transverse rectus abdominis musculocutaneous flaps typically sacrifice the entire muscle. In our experience, the lateral strip of the rectus abdominis muscle can be spared in an attempt to maintain function and reduce morbidity. When the intercostal nerves are injured, muscle atrophy appears with time. The severed intercostal nerve was reinserted into the remnant lateral strip of the rectus abdominis muscle to reduce muscle atrophy.
  
  
  METHODS
  The authors retrospectively reviewed 9 neurotized cases and 10 non-neurotized cases. Abdominal computed tomography was performed to determine the area of the rectus muscles. Electromyography (EMG) was performed to check contractile function of the remnant muscle. A single investigator measured the mean areas of randomly selected locations (second lumbar spine) using ImageJ software in a series of 10 cross-sectional slices. We compared the Hounsfield unit (HU) pre- and postoperatively to evaluate regeneration quality.
  
  
  RESULTS
  In the neurotization group, 7 of 9 cases maintained the mass of remnant muscle. However, in the non-neurotization group, 8 of 10 lost their mass. The number of totally atrophied muscles in each of the two groups was significantly different (P=0.027). All of the remnant muscles showed contractile function on EMG. The 9 remaining remnant rectus abdominis muscles showed declined the HU value after surgery but also within a normal range of muscle.
  
  
  CONCLUSIONS
  Neurotization was found to be effective in maintaining the mass of remnant muscle. Neurotized remnant muscle had contractile function on EMG and no fatty degeneration by HU value.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Woonhyeok
authors.initials: W
authors.lastname: Jeong
authors.forename: Daegu
authors.initials: D
authors.lastname: Son
authors.forename: Hyeonjung
authors.initials: H
authors.lastname: Yeo
authors.forename: Hoijoon
authors.initials: H
authors.lastname: Jeong
authors.forename: Junhyung
authors.initials: J
authors.lastname: Kim
authors.forename: Kihwan
authors.initials: K
authors.lastname: Han
authors.forename: Soyoung
authors.initials: S
authors.lastname: Lee
keywords: Electromyography; Multidetector computed tomography; Nerve transfer; Rectus abdominis
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