Assessement of the Correction of Rectus Abdominis Muscles Diastasis Using Two Different Techniques | ||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||
| Article 19, Volume 43, Issue 2, July 2019, Pages 271-282 PDF (9.01 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejprs.2019.65094 | ||
| Authors | ||
| Nada A Mahmoud* 1; Wafaa R Abdel Hamid2 | ||
| 1The Departments of Plastic, Burn and Maxillofacial Surgerym Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||
| 2The Departments of Radio Diagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||
| Abstract | ||
| Introduction: The technique used for correction of rectus abdominis diastasis has been a debatable issue since the original description of abdominoplasty. The aim of this study is to assess the durability of the correction of midline diastases done by two different techniques (the rectus abdominis myofascial release technique and the conventional midline plication) and their effect on waist enhancement and its safety in the terms of the intraabdominal pressure changes and respiratory affection that occur after plication. Patients and Methods: The study was conducted on 12 females with body mass index less than 30, having Rohrich type IV B deformities. The patients were divided randomly into two groups based on the technique used for plication of anterior rectus sheath: Group (A) 6 patients underwent myofascial release technique, while group (B) 6 patients underwent conventional midline plication. The two groups were compared as regards; 1- The width of rectus diastasis using computed tomography of their anterior rectus abdominis sheath pre-and post-operatively at 1 and 6 and as regards 3 points: (A) At the umbilicus, (B) Midway between umbilicus and xiphoid process and (C) Midway between umbilicus and symphysis pubis 2- Waist hip ratio pre-and post-operatively at 1 and 6 months. 3- Evaluation of ventilatory function using spirometry and intraoperative measurement of intra-abdominal pressure before and after plication. Results: Post-operative follow-up time averaged 8 months (range 6-10 months). Group A showed significant decline in the diastasis distance and increase in WHR than group B. There was a significant reduction in spirometry values and increase in IAP in group A rather than group B after surgery but there was no clinical differences in the respiratory function between both groups. Conclusion: Plication of the anterior rectus sheath using myofascial repair technique showing nonsignificant residual diastasis six months post operatively and has a better effect on the waist enhancement than the conventional plication with no respiratory complication. | ||
| Keywords | ||
| Rectus abdominis – Diastasis – Techniques | ||
| References | ||
|
REFERENCES 1- Chaouat M., Levan P., Lalanne B., Buisson T., Nicolau P. and Mimoun M.: Abdominal dermolipectomies: Early postoperative complications and long-term unfavorable results. Plast. Reconstr. Surg., Dec., 106 (7): 1614-8; discussion 1619-23, 2000. 2- Nahas F.X., Augusto S.M. and Ghelfond C.: Nylon versus polydioxanone in the correction of rectus diastasis. Plast. Reconstr. Surg., 107: 700e6, 2001. 3- Van Uchelen J.H., Kon M. and Werker P.M.: The longterm durability of plication of the anterior rectus sheath assessed by ultrasonography. Plast. Reconstr. Surg., 107: 1578e84, 2001. 4- Yousif N.J., Lifchez S.D. and Nguyen H.H.: Transverse rectus sheath plication in abdominoplasty. Plast. Reconstr. Surg., 1; 114 (3): 778-84, 2004. 5- Baroudi R. and Ferreira C.A.: Contouring the hip and the abdomen. Clin. Plast. Surg., Oct., 23 (4): 551-72; discussion 572-3, 1996. 6- Nahas F.X.: Advancement of the external oblique muscle flap to improve the waistline: A study in cadavers. Plast. Reconstr. Surg., Aug., 108 (2): 550-5, 2001. 7- Nahas F.X., Augusto S.M. and Ghelfond C.: Should diastasis recti be corrected? Aesthetic. Plast. Surg., Jul.- Aug., 21 (4): 285-9, 1997. 8- Akram J. and Matzen S.H.: Rectus abdominis diastasis. J. Plast. Surg. Hand Surg., Jun., 48 (3): 163-9, 2014. 9- Ramirez O.M.: Abdominoplasty and abdominal wall rehabilitation: A comprehensive approach. Plast. Reconstr. Surg., Jan., 105 (1): 425-35, 2000. 10- Manu L.N.G. Malbrain, Nele Desie, Alexandra Willems, Inneke De laet, Hilde Dits, Niels Van Regenmortel, Karen Schoonheydt and Martine Van De Vyvere: Intra-abdominal pressure measurement using the Foley Manometer does not increase the risk for urinary tract infection in critically ill patients Annals of Intensive Care, December, 2: S10, 2012. 11- American Thoracic Society: Lung function testing. Selection of reference values and interpretative strategies. American Review of Respiratory Diseases, 144: 1202- 1218, 1991. 12- Beer G.M., Schuster A., Seifert B. and Manestar M.: The normal width of the linea alba in nulliparous women. Clin. Anat., 22: 706-711, 2009. 13- Fisher M.L. and Voracek M.: The shape of beauty: Determinants of female physical attractiveness. J. Cosmet. Dermatol., 5 (2): 190-4, 2006. 14- Ferreira L.M., Castilho H.T., Hochberg J., Ardenghy M., Toledo S.R., Cruz R.G. and Tardelli H.: Triangular mattress suture in abdominal diastasis to prevent epigastric bulging. Ann. Plast. Surg., Feb., 46 (2): 130-4, 2001. 15- Serra-Renom J.M., Martinez-Teixido L., Serra-Mestre J.M.: Abdominoplasty with Customized Transverse Musculoaponeurotic Plications. Plast. Reconstr. Surg., Dec., 136 (6): 741e-9e, 2015. 16- Gama L.J.M., Barbosa M.V.J., Czapkowski A., Ajzen S., Ferreira L.M. and Nahas F.X.: Single-Layer Plication for Repair of Diastasis Recti: The Most Rapid and Efficient Technique. Aesthet. Surg. J., Jun. 1, 37 (6):698-705, 2017. 17- Netscher D.T., Wigoda P., Spira M. and Peltier M.: Musculoaponeurotic plication in abdominoplasty: How durable are its effects? Aesthetic. Plast. Surg., 19: 531- 534, 1995. 18- Mestak O., Kullac R., Mestak J., Nosek A., Krajcova A. and Sukop A.: Evaluation of the long-term stability of sheath plication using absorbable sutures in 51 patients with diastasis of the recti muscles: An ultrasonographic study. Plast. Reconstr. Surg., Nov., 130 (5): 714e-719e, 2012. 19- Tadiparthi S.1., Shokrollahi K., Doyle G.S. and Fahmy F.S.: Rectus sheath plication in abdominoplasty: Assessment of its longevity and a review of the literature. J. Plast. Reconstr. Aesthet. Surg., Mar., 65 (3): 328-32, 2012. 20- Birdsell D.C., Gavelin G.E., Kemsley G.M. and Hein K.S.: ''Staying power'': Absorbable vs nonabsorbable. Plast. Reconstr. Surg., 68: 742, 1981. 21- Mendes D.A., Nahas F.X., Veiga D.F., et al.: Ultrasonography for measuring rectus abdominis diastasis muscles. Acta. Cir. Bras., 22: 182-186, 2007. 22- De Castro E.J., Radwanski H.N., Pitanguy I. and Nahas F.: Long-term ultrasonographic evaluation of midline aponeurotic plication during abdominoplasty. Plast. Reconstr. Surg., Aug., 132 (2): 333-8, 2013. 23- Elkhatib H., Buddhavarapu S.R., Henna H. and Kassem W.: Abdominal Musculoaponeuretic System: Magnetic Resonance Imaging Evaluation before and after Vertical Plication of Rectus Muscle Diastasis in Conjunction with Lipoabdominoplasty. Plast. Reconstr. Surg., 128: 733e- 740e, 2011. 24- Tercan M., Bekerecioglu M., Dikensoy O., Kocoglu H., Atik B., Isik D. and Tercan A.: Effects of abdominoplasty on respiratory functions: A prospective study. Ann. Plast. Surg., 49 (6): 617-620, 2002. 25- Watson R.A. and Howdieshell T.R.: Abdominal compartment syndrome. South Med. J., 91 (4): 326-332, 1998. 26- Pereira N., Sciaraffia C., Danilla S., Parada F., Asfora C. and Moral C.: Effects of abdominoplasty on intraabdominal pressure and pulmonary function. Aesthetic Surgery Journal, Feb. 9, 36 (6): 697-702, 2016. 282 Vol. 43, No. 2 / Assessement of the Correction of Rectus Abdominis Muscles Diastasis 27- Wilhelmsson S., Fagevik Olsén M., Staalesen T., Elander A. and Nygren-Bonnier M.: Abdominal plasty with and without plication-effects on trunk muscles, lung function, and self-rated physical function. J. Plast. Surg. Hand Surg., Jun., 51 (3): 199-204, 2007. 28- Rodrigues M.A., Nahas F.X., Gomes H.C. and Ferreira L.M.: Ventilatory function and intra-abdominal pressure in patients who underwent abdominoplasty with plication of the external oblique aponeurosis. Aesthetic Plast. Surg., Oct., 37 (5): 993-9, 2013. 29- Talisman R., Kaplan B., Haik J., Aronov S., Shraga A. and Orenstein A.: Measuring alterations in intra-abdominal pressure during abdominoplasty as a predictive value for possible post-operative complications. Aesthetic Plast. Surg., 26 (3): 189-192, 2002. 30- Neto L.G., Araujo L.R., Rudy M.R., Auersvald L.A. and Graf R.: Intraabdominal Pressure in Abdominoplasty Patients. Aesth. Plast. Surg., 30: 655-658, 2006. 31- Al-Basti H.B., El-Khatib H.A., Taha A., Sattar H.A. and Bener A.: Intraabdominal pressure after full abdominoplasty in obese multiparous patients. Plast. Reconstr. Surg., Jun., 113 (7): 2145-50; discussion 2151-5, 2004. 32- Gabriel A., Gupta S.C. and Freeman B.G.: Abdominoplasty. eMedicine. http://www.emedicine.com/plastic/topic12. HTM. Accessed 12 Nov 2010, 2010. 33- Saggi B.H., Sugerman H.J., Ivatury R.R. and Bloomfield G.L.: Abdominal compartment syndrome. J. Trauma, 45 (3): 597-609, 1998. 34- Hewlett A.M. and Branthwaite M.A.: Post-operative pulmonary function. Br. J. Anaesth., 47 (2): 102-107, 1975. | ||
|
Statistics Article View: 261 PDF Download: 637 |
||
