PDF herunterladen
CC BY 4.0 · Arch Plast Surg 2025; 52(01): 003-010
DOI: 10.1055/a-2350-8420
Breast/Trunk
Original Article

Relation of Transversus Abdominis to Rectus Abdominis Muscle in Various Anatomical Landmark Levels: A Cadaveric Study

Totsapol Surichamorn 
1   Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Thiti Tantitham 
1   Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
› Institutsangaben Funding None.
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Background Posterior Component Separation (PCS) is a surgical technique used in abdominal wall reconstruction. Understanding the relationship between the rectus abdominis and transversus abdominis muscles and the location of intercostal nerves is crucial for minimizing nerve injury during PCS. This cadaveric study aimed to investigate these anatomical relationships and propose practical guidelines for safer PCS procedures.

Methods Eighteen fresh cadavers were dissected to assess the overlap or separation of the rectus abdominis and transversus abdominis muscles at seven abdominal levels. The distance of intercostal nerves from the lateral border of the rectus abdominis was measured.

Results The study found that the muscles overlapped at the xiphoid and upper abdominal levels but began to separate below the 2/4 upper to umbilicus level. Intercostal nerves entered at varying distances from the lateral edge of the rectus abdominis, suggesting that levels above the 3/4 upper to umbilicus level are relatively safe for dissection.

Conclusion The study recommends initiating the first incision for PCS between the subxiphoid and 2/4 upper to the umbilicus, based on observed muscle relationships and nerve distances. This practical approach enhances safety and simplifies decision-making during surgery.

Keywords

transversus abdominis - rectus abdominis - posterior component separation

Authors' Contributions

Co-written by both authors.


Ethical Approval

This study has received IRB approval from Mahidol University. IRB approval number is COA. MURA2019/818


Patient Consent

Informed consent has been obtained fromthe patients for the use of clinical photographs and medical images.




Publikationsverlauf

Eingereicht: 19. September 2023

Angenommen: 12. Mai 2024

Accepted Manuscript online:
24. Juni 2024

Artikel online veröffentlicht:
06. August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990; 86 (03) 519-526
    CrossrefPubMedSuche in Google Scholar
  • 2 Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 2012; 204 (05) 709-716
    CrossrefPubMedSuche in Google Scholar
  • 3 Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ. Posterior and open anterior components separations: a comparative analysis. Am J Surg 2012; 203 (03) 318-322 , discussion 322
    CrossrefPubMedSuche in Google Scholar
  • 4 Drake RL. Gray's Anatomy for Students. 4th ed.. Cleveland: Elsevier; 2019: 218-283
    Suche in Google Scholar
  • 5 Netter FH. Atlas of Human Anatomy. 6th ed.. Saunders; 2014: 242-249
    Suche in Google Scholar
  • 6 Netter FH. Netter's Clinical Anatomy. 4th ed.. Elsevier; 2019: 157-162
    Suche in Google Scholar
  • 7 Agur AM, Dalley AF. Grant's Atlas of Anatomy. 13th ed.. Lippincott Williams & Wilkins; 2012: 98-110
    Suche in Google Scholar
  • 8 Wineski L. Snell's Clinical Anatomy. 10th ed.. Lippincott Williams & Wilkins; 2018: 692-706
    Suche in Google Scholar
  • 9 Lumley JSP, Craven J, Abrahams P, Tunstall R. Bailey & Love's Essential Clinical Anatomy. CRC Press; 2018: 80-83
    CrossrefSuche in Google Scholar
  • 10 Chummy SS. Last's Anatomy. 12th ed.. Elsevier; 2011: 221-226
    Suche in Google Scholar
  • 11 Punekar IRA, Khouri JS, Catanzaro M, Shaikh AL, Langstein HN. Redefining the rectus sheath: implications for abdominal wall repair. Plast Reconstr Surg 2018; 141 (02) 473-479
    CrossrefPubMedSuche in Google Scholar
  • 12 Petro CC, Como JJ, Yee S, Prabhu AS, Novitsky YW, Rosen MJ. Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen. J Trauma Acute Care Surg 2015; 78 (02) 422-429
    CrossrefPubMedSuche in Google Scholar
  • 13 Petro CC, Orenstein SB, Criss CN. et al. Transversus abdominis muscle release for repair of complex incisional hernias in kidney transplant recipients. Am J Surg 2015; 210 (02) 334-339
    CrossrefPubMedSuche in Google Scholar
  • 14 Poulose BK. Transversus abdominis muscle release: innovations in technique can still happen. Ann Surg 2016; 264 (02) 233-234
    CrossrefPubMedSuche in Google Scholar
  • 15 Blatnik JA, Krpata DM, Novitsky YW. Transversus abdominis release as an alternative component separation technique for ventral hernia repair. JAMA Surg 2016; 151 (04) 383-384
    CrossrefPubMedSuche in Google Scholar
  • 16 Jones CM, Winder JS, Potochny JD, Pauli EM. Posterior component separation with transversus abdominis release: technique, utility, and outcomes in complex abdominal wall reconstruction. Plast Reconstr Surg 2016; 137 (02) 636-646
    CrossrefPubMedSuche in Google Scholar
  • 17 Gazzola R, Lombardo M, Rosati R, Baruffaldi Preis FW. Posterior component separation with transversus abdominis release: technique, utility, and outcomes in complex abdominal wall reconstruction. Plast Reconstr Surg 2016; 138 (03) 562e-563e
    CrossrefPubMedSuche in Google Scholar