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Dynamic rectus abdominis muscle flap for intestinal stomal continence: a systematic approach
W K Stadelmann1, J W Bardoel, G Perez-Abadia
1Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, 511 South Floyd Street, Louisville, KY 40292, USA.
Microsurgery
|December 18, 2001
Summary
This study developed a new continent stomal sphincter using the rectus abdominis muscle. The novel sphincter achieved sustained continence, overcoming previous limitations like muscle fatigue.
Area of Science:
- Surgical innovation
- Abdominal wall reconstruction
- Stomal therapy
Background:
- Previous continent stomal sphincter attempts using dynamic myoplasty faced challenges.
- Denervation atrophy and muscle fatigue limited the success of prior stomal sphincter designs.
Purpose of the Study:
- To design and evaluate a novel stomal sphincter using the rectus abdominis muscle.
- To assess the short-term efficacy of a rectus abdominis muscle island flap for stomal continence.
Main Methods:
- A stomal sphincter was created using the caudal segment of the rectus abdominis muscle.
- The rectus abdominis muscle island flap sphincter was tested for continence under various intraluminal bowel pressures.
- Two electrical stimulation protocols were employed to assess sphincter function and endurance.
Main Results:
- The rectus abdominis muscle sphincter generated peak pressures exceeding the 60 mm Hg requirement for stomal continence.
- All created sphincters successfully maintained stomal continence across all tested intraluminal pressures.
- One electrical stimulation protocol demonstrated superior results, achieving 4 hours of continence after 8-10 weeks of stimulation.
Conclusions:
- A continent stomal sphincter constructed from a rectus abdominis muscle island flap is a viable option.
- This approach effectively overcomes denervation atrophy and muscle fatigue issues.
- Optimized electrical stimulation protocols are crucial for achieving prolonged stomal continence.