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Ultrasonic Mapping of the Abdominal Wall using ARFI-SWV: A Prospective Trial to Determine the Physiologic Basis for Reconstruction
Martin J. Carney, III, B.S., Jason M. Weissler, M.D., Michael A. Lanni, B.S., David Gabrielsen, B.S., Jorge Hernandez, B.S., Laith Sultan, M.D., Fabiola Enriquez, B.A., Chandra Sehgal, M.D., Anil Cauhan, M.D., John P. Fischer, M.D., M.P.H..
University of Pennsylvania, Philadelphia, PA, USA.

PURPOSE: Current indices of risk evaluation for abdominal wall reconstruction focus on thickness and fat measurements, but do not address abdominal wall elasticity and texture assessment. Acoustic-Radiation-Forced-Impulse-Shear-Wave-Velocity (ARFI-SWV) is a novel technology to assess skeletal muscle tissue characteristics. This technique has not assessed the abdominal wall physiology for reconstructive patients on a plastic surgery service.
METHODS: Texture analysis and ARFI-SWV of the internal and external oblique (IO and EO) were performed on 36 subjects. Ten subjects qualified as high-physical activity according to IPAQ guidelines, sixteen were awaiting abdominal wall reconstruction, and ten were age and BMI matched to the operative candidates.
RESULTS: When comparing the active vs. pre-operative patient’s abdominal wall constructs, significant differences were shown in pre-hepatic fat thickness (p=0.037), pre-peritoneal fat thickness (p=0.005), IO thickness (p=0.001), subcutaneous fat thickness (p=0.003), and SWV in IO (p=0.023) and EO (p=0.013). The matched patients showed significant differences to the pre-operative grouping in pre-peritoneal fat thickness (p=0.022) and IO thickness (p=0.03). Finally the active and matched group differed in EO thickness (p=0.005). Mean brightness EO and IO ratio of hernia patients (EO 2.29; IO 1.59) was greater than matched controls (EO 2.05; IO 1.3) as well as the active controls (EO 1.2; IO 0.82).
CONCLUSION: ARFI-SWV is an excellent technique to measure stiffness of the abdominal wall musculature, providing consistent results. Textural analysis has potential to predict abdominal wall weakness. The physiologic basis of the abdominal wall in reconstruction patients differs from healthy counterparts, contributing to eventual failure and need for repair.


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