Ultrasound Imaging Evaluation of Abdominal Muscles After Breast Reconstruction With a Unilateral Pedicled Transverse Rectus Abdominis Myocutaneous Flap

Lih-Jiun Liaw; Sin-Daw Lin; Lan-Yuen Guo; Yi-You Hou; Ming-Feng Hou; Ar-Tyan Hsu

doi:10.2522/ptj.20120063

Figures

Figure 1.

Ultrasound images of the donor (right) side (left panel) and the intact (left) side (right panel) of the rectus abdominis (RA) muscle at rest and upon contraction in a 45-year-old woman with a muscle-sparing unilateral pedicled transverse rectus abdominis myocutaneous flap. The medial and lateral edges of the RA muscle are represented by asterisks. The interval between the plus signs represents the thickest part of the RA muscle. The thickness of the RA muscle was measured at 3 levels: (A) upper=costochondral junction of the ninth rib, (B) middle=halfway between the lower rib margin and the iliac crest, (C) 5 cm below the iliac crest. The thickest part of the remnant RA muscle upon contraction can be seen in the lateral half of the middle location.

Figure 2.

Ultrasound images of the intact (left) side of the rectus abdominis (RA) muscle at rest and upon contraction in a 45-year-old woman with a muscle-sparing unilateral pedicled transverse rectus abdominis myocutaneous flap. The cross-sectional area was measured by tracing around the inner border of the RA muscle at 3 levels: upper=costochondral junction of the ninth rib, middle=halfway between the lower rib margin and the iliac crest, lower=5 cm below the iliac crest. (A) Original image in relaxed or contracted state. (B) Superimposition of tracing on original image in relaxed or contracted state. The area in the tracing was measured.

Tables

Table 1.

Characteristics of Study Participants^{^a}

↵^a TRAM=transverse rectus abdominis myocutaneous, BMI=body mass index, IQR=interquartile range.
^b Data are reported as mean (SD), unless otherwise indicated.
^c As determined with the Mann-Whitney U test.
^d As determined with the chi-square test.
^e The ordinal data were obtained with a grading scale of 0 to 5 for trunk flexion strength and were analyzed with the Mann-Whitney U test (P<.05).
^f Significant difference between the TRAM flap group and the control group (P<.05).

Table 2.

Descriptive Statistics for Averaged Muscle Measurements in Women With the Muscle-Sparing Unilateral Pedicled TRAM Flap Procedure^{^a}

↵^a Descriptive statistics were based on scores averaged across 3 images. Measurements for the RA muscle were obtained parallel to 3 levels: upper=costochondral junction of the ninth rib, middle=halfway between the lower rib margin and the iliac crest, lower=5 cm below the iliac crest. Measurements for the lateral abdominal muscles were obtained at 1 location, halfway between the lower rib margin and the iliac crest along a vertical line passing through the anterior superior iliac spine. TRAM=transverse rectus abdominis myocutaneous, RA=rectus abdominis muscle, CSA=cross-sectional area, OE=obliquus externus abdominis muscle, OI=obliquus internus abdominis muscle, TrA=transversus abdominis muscle.
^b P values were determined with paired t tests. Significance for comparisons of the donor side with the intact side for all abdominal muscles was set at a P value of less than .05.

Table 3.

Comparison of Muscle Sizes in Women Who Had Breast Reconstruction^{^a} and Women Who Were Healthy^{^b}

↵^a Reconstruction was done with the muscle-sparing unilateral pedicled transverse rectus abdominis (RA) myocutaneous (TRAM) flap procedure.
^b Data were based on measurements obtained from 3 images for 34 women who had the TRAM flap procedure (TRAM group) and 25 women who were healthy (control group), unless otherwise indicated. Measurements for the RA muscle were obtained parallel to 3 levels: upper=costochondral junction of the ninth rib, middle=halfway between the lower rib margin and the iliac crest, lower=5 cm below the iliac crest. Measurements for the lateral abdominal muscles were obtained at 1 location, halfway between the lower rib margin and the iliac crest along a vertical line passing through the anterior superior iliac spine. CI=confidence interval, CSA=cross-sectional area, OE=obliquus externus abdominis muscle, OI=obliquus internus abdominis muscle, TrA=transversus abdominis muscle.
^c Data are reported as mean (SD). The control side was the side of the rectus abdominis muscle in women in the control group corresponding to the intact side of the rectus abdominis muscle in women in the TRAM group.
^d 95% CI for comparisons of muscle sizes normalized by body weight.
^e The results for the TRAM group were significantly different from those for the control group (P<.05).
^f Measurements were obtained from 25 women.

Table 4.

Visibility of Muscle Contours and Echogenicity of the Remnant Rectus Abdominis Muscle at 3 Locations (n=34)^{^a}

↵^a Measurements were obtained parallel to 3 levels: upper=costochondral junction of the ninth rib, middle=halfway between the lower rib margin and the iliac crest, lower=5 cm below the iliac crest. IQR=interquartile range.
^b Ordinal data on a scale from 0 to 2 were analyzed with Friedman tests.
^c A grade of 2 on at least 1 of the 2 scales is an indication of fatty atrophy.

Supplementary Data

eFigures and eTables

Files in this Data Supplement:

eFigures and eTables (PDF) (1.8 MB) - This PDF contains the following eFigures eTables:
- eFigure 1. Schematic diagram of the abdominal wall
- eFigure 2. Isometric position used for ultrasound imaging of the rectus abdominis muscle during contraction
- eFigure 3. Ultrasound images of the lateral abdominal muscles at rest in a 45-year-old woman with a muscle-sparing unilateral pedicled transverse rectus abdominis myocutaneous flap.
- eTable 1. Criteria for Scoring Muscle Strength of Trunk Flexion
- eTable 2. Interimage Reliability of Rectus Abdominis Muscle Measurements at 3 Locations
- eTable 3. Descriptive Statistics for Averaged Bilateral Rectus Abdominis Muscle Measurements in Women With the Pedicled TRAM Flap Procedure

Vol 93 Issue 3 Table of Contents

Issue highlights

Ultrasound Imaging Evaluation of Abdominal Muscles After Breast Reconstruction With a Unilateral Pedicled Transverse Rectus Abdominis Myocutaneous Flap