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Title:
Electrophysiological assessment of the gracilis muscle,transposed during the graciloplasty procedure
Author:
Subject:
gracilis muscle ; dynamic graciloplasty ; surface electromyography ; fecal incontinence ; electrical stimulation
Abstract:
In the group of patients qualified for graciloplasty, clinical, functional and qualityof life assessment was made. Surface EMG of the gracilis muscle was performedbefore surgery. The distance between the proximal attachment and the nerveentry point was identified intraoperatively. All patients underwent EMG looptransposed gracilis muscle, the signal was compared with the records from themuscle on the left thigh.In the clinical analysis significant improvement was observed in continence andquality of life. A manometry showed improvement in pressures, significantlyhigher in the adynamic graciloplasty group. In the EMG assessment theinnervation zone was an average of 65,5mm from proximal attachment.Intraoperatively it was confirmed that nerve entered the muscle on average 62mm from the attachment (mean difference 2.8 mm). The frequency of motor unitpotentials in the gracilis muscle in the thigh was 64Hz on average, after thetransposition and the stimulation of the muscle it was 62Hz on average. Therewere no differences before and after treatment, or between groups with differentstimulation methods. There was a significant correlation between clinicaloutcome and the average amplitude of the EMG signal.Adynamic graciloplasty can be an alternative to the dynamic graciloplasty. Interms of electrophysiology, the characteristics of motor units has not changedcompared to the state before ; the surgery. Surface electromyography proved to bea safe, reliable and precise method for electrophysiological evaluation of thegracilis muscle.