Rectus fascia

The use of allografts and xenografts in pelvic floor reconstruction has its origins in the use of autologous materials, namely the rectus fascia, or fascia lata, and even dermis, particularly in the treatment of The use of these materials when... 

Howden NS, Zyezynski HM, Moalli PA, Sagan ER, Meyn LA, Weber AM. Comparison of autologous rectus fascia and cadaveric fascia in pubovaginal sling continence outcomes. Am J Obstet Gynecol 2006 194 1444-9. 

Classically, the venous approach establishes where the device will be implanted. Historically, the venous approach used for lead implantation was the ileofemoral vein. Once a small incision immediately below the inguinal ligament was performed, the operator had to carry the dissection down to the fascia above the vein. At this point, the iliac vein was entered with a standard puncture technique, and after lead implantation, it was tunneled to the abdominal pocket. For this venous approach, the device was actually housed in the abdominal region. The pocket was created lateral to the umbilicus and superficial to the rectus sheath [30, 31]. This is not the standard method for PM implantation used today, but it is important to know this approach in the event that more com-... 

Fig. 5.3. a Scan of the anterior abdominal wall with Valsalva manoeuvre shows the ventral hernia containing the bowel loops (BO) and the defect in the fascia (arrows), b Fatty epigastric hernia with herniation of the properitoneal fat (arrows), c Spigelian hernia shows the defect marked by calipers lateral to the rectus muscle (R) and the contents (BO) limited anteriorly by the Spigelian fascia (arrow), d Richter s type umbilical hernia shows fluid-filled hernial sac (arrowheads) and irreducible herniation of only a part of the circumference of the bowel (arrow), which showed wriggling peristaltic movement in real time... 

If an abdominal pocket is to be created, one mnst be completely familiar with the anatomy of the anterior abdominal wall. This inclndes the mnltiple muscular and fascia layers (Fig. 4.46). One must be completely familiar with the anterior rectus sheath, rectus muscle and posterior rectus shealh, linea alba, and peritoneum. Failure to appreciate the anatomic relationships of the abdominal wall may result in inadvertent access of peritoneal cavity. An abdominal pocket... 

Rather than exist in a segregated fashion, the various fasciae show continuous communication. Suspensory ligaments of the heart and other organs represent continuities. The recently discovered connection between the dura and the rectus capitis posterior minor is an example of the continuity and interrelatedness of bodily structures. The inguinal ligament is a reflection of the in-rolled lower edge of the external oblique muscle aponeurosis. 

The hip bones give rise to many muscular attachments. Cranial to the acetabulum, the ilium also has two prominent projections on its anterior margin the anterior superior iliac spine, which may easily be visible through the skin of slender subjects, and the anterior inferior iliac spine (Fig. 12.1a). The first gives insertion to the tensor fasciae latae and sartorius, the second to the rectus femoris. Medially, the iliac fossa... 

The muscles and tendons of the anterior hip can be divided in two groups superficial (sartorius and tensor fasciae latae) and deep (rectus femoris, iliopsoas and pectineus). Superficial muscles can be easily delineated with high US frequencies, whereas deep muscles may require switching the transducer frequency down for an adequate examination. 

Fig. 12.2. Anatomy of the anterior muscles and tendons of the hip. Schematic drawing of an anterior view through the hip illustrates the relationships of the anterior muscles to each other. The superficial tensor fasciae latae (Tfl) and sartorius (Sfl) arise from the anterior superior iliac spine (straight arrow). On a deeper plane, the rectus femoris (Rf) originates from the anterior inferior iliac spine (arrowhead). Observe the iliacus and the psoas muscles which join distally to insert through a common tendon onto the lesser trochanter (curved arrow). Medially to the iliopsoas tendon, the pectineus muscle (Pe) can be seen arising from the anterior aspect of the superior ramus of the pubis (Pb)...

Fig. 12.3a-h. Anatomy of the anterior group (flexors) of muscles and tendons of the hip. Series of schematic drawings (a,c,e,g) and corresponding T1-weighted MR images (b,d,fdi) illustrate the relationship among the tensor fasciae latae (TfL)(JVL), iliopsoas (IPs), sartorius (Sa) and rectus femoris (RF) in transverse planes obtained from proximal to distal. Muscle bellies are represented in intermediate gray, tendons in black. In a,b, a white arrowhead indicates the rectus femoris tendon. Note that the sartorius muscle crosses the iliopsoas from lateral to medial as it proceeds downwards. Arrow, fasciae latae... 

The anterior muscles detected at the articular level are, from lateral to medial the tensor fasciae latae, the rectus femoris, the sartorius, the iliopsoas and the pectineus. Over the joint space, the iliopsoas muscle is the first to be identified in a lateral position relative to the femoral neurovascular bundle. Its tendon lies in an eccentric position within the posterior part of the muscle belly and can be detected as a hyperechoic anisotropic fibrillar structure (Fig. 12.14). The tendon is in close relationship with the anterior hip capsule and the two structures can usually be distinguished... 

Overuse tendinopathies of the hip affect mostly the tendon of the tensor fasciae latae (Bass and Connel 2002) and the rectus femoris tendon. Patients complain of localized anterior hip pain vdiich comes on after or, in more severe disease, during sport activities. This condition typically involves sprinters and is secondary to a forceful extension of the hip. Physical examination reveals tenderness over the anterior superior and anterior inferior iliac spines. Contraction of the muscle against resistance can increase the local pain. Clinically, the diagnosis of tensor fasciae... 

A 3 mm difference in thickness (from the femoral shaft to the anterior fascia of the rectus femoris) between the affected and the healthy quadriceps was found as the threshold value this sign can also be encountered, however, in patients with other long-lasting hip disorders, including slipped upper femoral epiphysis and transient synovitis (Robben et al. 1998,1999b). Based on the combination of the above... 

If the needle electrode is inserted too deeply or too distally it will be in the rectus femoris if inserted too medially it will be in the iliacus if inserted too laterally it will be in the tensor fascia lata. 

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