High-Frequency Ultrasound: A Useful Tool for Evaluating the Abdominal Wall following Free TRAM and DIEP Flap Surgery
Bibliographic record
Abstract
BACKGROUND: This is the first study to use a standardized ultrasound protocol to evaluate hernia and abdominal wall laxity following free transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric perforator (DIEP) flap surgery. METHODS: All patients who underwent free TRAM and DIEP flap surgery performed by the senior author between the years 1994 and 2003 were recruited for physical examination and ultrasound of the abdominal wall for the dynamic evaluation of hernia and abdominal wall laxity. RESULTS: A total of 25 of 28 patients were followed up (89 percent). Eleven were in the DIEP flap group (44 percent) and 14 were in the free TRAM flap group (56 percent). Age- and body habitus-matched female volunteers (n = 12) were also used in this study. The mean follow-up was 3.8 years (range, 0.8 to 8.2 years). Although the kappa coefficient was +1 for detection of hernia on physical examination between two independent examiners, the interobserver correlation was poor for detection of bulges (kappa coefficient, +0.53). Ultrasound showed that abdominal wall laxity was statistically highest in the upright position, followed by 30 degrees of truncal flexion, and lowest in the supine position. The amount of abdominal wall laxity detected by ultrasound was significantly higher in the free TRAM flap group than in the free DIEP flap group. Two hernias were detected in the TRAM flap group by ultrasound and one hernia was previously known in the DIEP flap group. CONCLUSION: This is the first study to establish a standardized ultrasound protocol as an adjunct diagnostic tool to clinical examination for the dynamic evaluation of postoperative hernia and abdominal wall laxity.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".