Electrically stimulated sartorius neosphincter: Canine model of activation and skeletal muscle transformation

Hallan, R. I.; Williams, Norman S.; Hutton, M.; Scott, Mark; Pilot, M. A.; Swash, Michael; Koeze, T. H.; Watkins, Eric

doi:10.1002/bjs.1800770226

Cited by 54 publications

(14 citation statements)

References 26 publications

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“…7,9 These original studies were conducted with an eye toward using the latissimus dorsi muscle to assist a failing heart in a procedure termed dynamic cardiomyoplasty. They demonstrated that when trained, skeletal muscle could be made to contract over prolonged periods in synchrony with the heart without fatiguing.…”

Section: Background and Historymentioning

confidence: 99%

Dynamic graciloplasty for fecal incontinence

Baeten¹,

Uludag²,

Rongen³

2001

Microsurgery

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Fecal incontinence is a socially incapacitating condition with associated high treatment costs. The most common cause of fecal incontinence is trauma during childbirth followed by surgical interventions. After unsuccessful conventional treatment, muscle transposition is the next treatment option. Two local muscles are used for this purpose: the gluteus and the gracilis muscles. With both muscles, long-term muscle contractions are difficult to maintain due to muscle fatigue. The gracilis muscle, however, is technically much easier to transfer and most activities of daily living and even sports are still possible. Experimental studies have shown that electrical stimulation of skeletal muscles can transform fatigue-prone muscles into fatigue-resistant muscles. In 1986, we started to perform graciloplasty procedures with intramuscular electrodes connected to an electrical stimulator. To date, 200 patients have been treated in our institution using dynamic graciloplasty. All patients had severe incontinence without control of liquid or solid feces, most of them had previously received unsuccessful treatment using other techniques. The mean age was 48 years, the average time that patients had been incontinent was 12.4 years, and the cause of incontinence were trauma (n = 99), congenital (n = 28), pudendopathy (n = 58), and low motor neurological lesions (n = 15). Of these patients, 76% were considered to have successful outcomes. Patients whose cause of incontinence was trauma or pudendopathy tended to respond better to this treatment than patients with anal atresia.

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Section: Background and Historymentioning

confidence: 99%

Dynamic graciloplasty for fecal incontinence

Baeten¹,

Uludag²,

Rongen³

2001

Microsurgery

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show abstract

“…This procedure converts the gracilis from a predominantly fast-twitch ®ber muscle to a slow-twitch ®ber muscle by implanting, and subsequently stimulating the intramuscular electrodes via a pulse generator. 15 We have subsequently implanted a pulse generator with intramuscular electrodes in one patient (patient 4). After an 8 week stimulation training period, the patient noted subjective improvement and was able to stop using absorbent products needed for leakage (Chancellor, personal communication).…”

Section: Discussionmentioning

confidence: 99%

Gracilis urethromyoplasty – an autologous urinary sphincter for neurologically impaired patients with stress incontinence

et al. 1997

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Purpose: To investigate the eect of a neurovascularly intact gracilis muscle urethral wrap, to be used to restore urinary continence as a transposed urinary sphincter graft, in patients with neurogenic lower urinary tract dysfunction. Methods: Five neurologically impaired men with a denervated and damaged urinary sphincter mechanisms were treated. The etiology of sphincteric insuciency included sphincter denervation in three patients, external sphincterotomy in one, and urethral trauma due to a chronic indwelling catheter in one. All patients underwent gracilis urethromyoplasty sphincter reconstruction. Two patients also underwent concomitant ileocystoplasty and one patient ileocystostomy because of poor bladder compliance and a bladder capacity of 5200 ml. Results: The gracilis urethromyoplasty functioned as a new autologous sphincter with follow-ups ranging from 6 ± 35 months. The surgery was successful in four patients. Three of the four patients were managed with intermittent catheterization, and one managed by ileocystostomy. The ®fth patient continued to require an indwelling urethral catheter. Conclusion: Gracilis urethromyoplasty achieves compression of the urethra using a neurovascularly intact muscle graft. The functional urethral closure, obtained from the gracilis muscle wrap, assures dryness, and permits intermittent selfcatheterization. It also avoids the risks of infection, erosion, or malfunction associated with the arti®cical urinary sphincter. The potential exists for electrical stimulation of this muscle graft to allow volitional control of the neo-sphincter mechanism, and voluntary voiding.

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“…As a functioning pedicled flap, the gracilis muscle can be transferred for the treatment of anal incontinence (Melenhorst et al, 2007). This technique called graciloplasty was described in 1952 by Pickrell et al and was revolutioned in the late 1980s by the introduction of chronic muscle electrostimulation (Hallan et al, 1990). The gracilis microsurgical free flap is used commonly in the reconstruction of upper and lower limbs (Krimmer et al, 1995;Baker and Watson, 2007), in breast reconstruction (Arnez et al, 2004) and, as a free functioning flap, to restore forearm function or in dynamic reconstruction of facial paralysis (Harii et al, 1976;Taylor et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

The gracilis muscle and its use in clinical reconstruction: An anatomical, embryological, and radiological study

et al. 2008

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The gracilis muscle is used widely in reconstructive surgery, as a pedicled or as a free microsurgical flap, for soft tissue coverage or as a functioning muscle transfer. Many studies, based on cadaver dissections, have focused on the vascular anatomy of the gracilis muscle and provided different data about the number, origin, and caliber of its vascular pedicles. Computed tomographic (CT) angiography of both thighs of 40 patients (35 males and 5 females, mean age: 63 years) have been analyzed to provide a detailed anatomical description of the arterial supply of the gracilis muscle. The gracilis muscle had a mean length of 41 +/- 2.1 cm. The principal pedicle enters the gracilis muscle at a mean distance (+/-SD) of 10 +/- 1 cm from the ischiopubic attachment of the muscle. Its caliber shows a mean value of 2.5 +/- 0.5 mm, and it is statistically larger when originating directly from the deep femoral artery (45%) than from its muscular branch supplying the adductors, i.e., the "artery to the adductors" (46%) (P < 0.01). A significant correlation between the caliber of the artery of the main pedicle and the volume of the gracilis muscle was found (P < 0.01). The mean number of distal accessory pedicles is 1.8 (range, 1-4,) and the artery of the first of these pedicles shows a mean caliber of 2.0 mm. There is no correlation between either the number or the caliber of the artery of the accessory pedicles and the volume of the gracilis muscle. CT angiography, providing detailed images of the muscular and vascular structures of the thigh of each patient, could be a useful preoperative study for the reconstructive surgeon. It would allow a personalized planning of a gracilis flap, reducing the risk of iatrogenic damage.

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Electrically stimulated sartorius neosphincter: Canine model of activation and skeletal muscle transformation

Cited by 54 publications

References 26 publications

Dynamic graciloplasty for fecal incontinence

Dynamic graciloplasty for fecal incontinence

Gracilis urethromyoplasty – an autologous urinary sphincter for neurologically impaired patients with stress incontinence

The gracilis muscle and its use in clinical reconstruction: An anatomical, embryological, and radiological study

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