PubMed · 6229803
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M Lejour. 1984. Rectus abdominis flaps.. https://doi.org/10.1097/00006534-198402000-00048
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Lorisid locomotor and postural behaviour exhibits a number of features that distinguish it clearly from other primates. The comparative myological study of the trunk in the slow loris (Nycticebus coucang) and the squirrel monkey (Saimiri sp.) presented here reveals differences that are related to unique aspects of lorisid positional behaviour. While quadrupedal running and leaping requires flexion and extension of the spine, slow climbing quadrupedalism in lorisids depends on spinal lateral flexion and rotation. The contrasting development of the epaxial musculature in the two species dissected reflects these different requirements. Bipedal suspension is a common posture in the lorisids during which rotation and dorsiflexion of the head is made possible by the robustly developed deep, dorsal, cervical musculature. The long lower lever arm in the M. rectus abdominis may play a significant role in the ventroflexion required to regain a quadrupedal stance.
The presentation and management of 24 patients with endometriosis (median age 34 (range 21-68)years) presenting to general surgeons over a period of 10 years (1985-1994) was reviewed. Patients presented with an abdominal wall swelling related to a previous Pfannenstiel incision (seven patients), umbilical swelling (four), inguinal canal swelling (two), incidentally following appendicectomy (five), terminal ileal obstruction (two), rectal bleeding (two) and urinary symptoms (two). Endometriosis was not suspected in most patients but was confirmed by surgical excision or resection with minimal morbidity. No recurrence occurred during a median follow-up of 53 (range 9-113) months. Endometriosis is a disease rarely seen by general surgeons and is often diagnosed incidentally or on histological examination. Cyclical symptoms associated with menstruation are present in 50 per cent of patients and should suggest the diagnosis in those presenting with scar-related and/or subcutaneous swellings. Simple excision or resection of the presenting lesion provides adequate treatment but, since pelvic endometriosis may be present, referral to a gynaecologist is recommended in every case.
The usual dissection by medical students of the anterior abdominal wall and the inguinal region proceeds from superficial to deep; special emphasis is placed on the sheath of the rectus abdominis muscle and lateral muscular layers. We suggest an alternate approach to dissection of this region that has the following advantages: (1) sparing of delicate deep structures not often fully appreciated by students; (2) provision of an opportunity to visualize the region from a laparoscopic surgeon's vantage point; (3) considerably reduced time spent dissecting and identifying structures and relationships, especially peritoneal reflections important in laparoscopic procedures. Our dissection begins with bilateral subcostal incisions through the entire thickness of the anterior abdominal wall and peritoneum, which extend laterally and inferiorly to the level of the anterior superior iliac spines, thereby forming a large, inverted, U-shaped flap. This flap is reflected inferiorly, allowing abdominal viscera to be dissected, and ultimately removed en bloc. The flap is then drawn cranially and stretched somewhat to approximate its position when the abdomen is inflated with CO2 during laparoscopic procedures. Major landmarks, including the deep inguinal ring, are noted and the flap is again reflected inferiorly for dissection beginning with the peritoneum and transversalis fascia. This method of dissecting the anterior abdominal wall and inguinal region results in more facile and timely identification of both superficial and deep structures of the anterior abdominal wall and inguinal region, and provides a clinically relevant demonstration of anatomy from a laparoscopic perspective.