P029 HOW DOES THE MADRID APPROACH WORK

Aim The Madrid APPROACH is the combination of an absorbable mesh and a permanent retromuscular mesh for the treatment of the complex abdominal wall problems. It has been controversial because of the need of two different meshes. We present a clinic case to show the utility of this technique and how it allows rebuilding the inguinal ligament. Material and Methods 78 years old woman who underwent a right ilioinguinal and obturatriz lymphadenectomy due to a melanoma. Incisional hernia fixed in 2018 with a retromuscular polyester mesh. New incisional iliac hernia (L3) over the right iliac vessels, with an absence of inguinal ligament, right rectus atrophy, and the previous mesh being part of the sac. Surgery: incision over the previous scar. Wide dissection of the preperitoneal space, Retzius space and lateral to the cuadratus lumborum, retrodiafragmatic dissection, lateral transverse abdominus release, and cross-over to the retrorectal left space. Preperitoneal BioA mesh and an upper 40x40cm medium weight polipropilene mesh set to both Cooper ligaments. Results After two and a half months, a PET-TC showed the BioA mesh perfectly adapted to the abdominal wall and rebuilt a new inguinal ligament. Also intense FDG capitation of the mesh due to the high cellular metabolism. Two years later the patient has a continent abdominal wall, the follow up TC shows the disappearance of the absorbable mesh and the perfect abdominal wall rebuilt. Conclusions The BioA mesh acts like a tissue scaffold for new conjunctive tissue as we see the intense FDG captation. The Madrid APPROACH allows giving response to very complex abdominal wall problems.

Pattern of changes in latissimus dorsi, gluteus maximus, internal oblique and transverse abdominus muscle thickness among individuals with sacroiliac joint dysfunction

Background and Objective: Altered Pattern of the Global Muscle system is presented in literature among individuals with sacroiliac Joint Dysfunctions. However, the pattern of changes in the Latissimus dorsi (LD) and gluteal maximus (GM) among sacroiliac joint dysfunctions (SIJD) is not reported. This study aimed to investigate the changes in the resting muscle thickness of the Latissimusdorsi and gluteal maximus in SIJD. Method: A total of 88 subjects (44 individuals with SIJD and 44 healthy individuals as matched control) was included in this study. The resting thickness of the Latissimusdorsi and gluteal maximus was measured using real time musculoskeletal ultrasonography and data was compared between the ipsilateral side and contra lateral side among subjects with SIJD as well as healthy subjects. Independent sample t test was used to analyze the data by using SPSS version-25. Results: The results showed that contralateral LD were reduced significantly among subjects with SIJD when compared with the other side and with control. It also showed that ipsilateral IO, TrA and GM were reduced significantly among subjects with SIJD when compared with the controls and with contralateral side. Conclusion: The reduced resting muscle thickness showed an altered motor pattern of Deep Muscles of local system and Gross muscles of global system among patients with sacroiliac joint dysfunction. doi: https://doi.org/10.12669/pjms.35.3.62 How to cite this:Bashir MS, Noor R, Hadian MR, Olyaei G. Pattern of changes in latissimus dorsi, gluteus maximus, internal oblique and transverse abdominus muscle thickness among individuals with sacroiliac joint dysfunction. Pak J Med Sci. 2019;35(3):---------. doi: https://doi.org/10.12669/pjms.35.3.62 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.