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de Abranches Oliveira Santos Filho ID, Rodrigues MA, Ferreira LM, Nahas FX. Is There a Direct Effect Between the Plication of the Myoaponeurotic Layer and the Force of Inspiratory and Expiratory Muscles After Abdominoplasty? Ann Plast Surg 2024; 93:14-21. [PMID: 38885160 DOI: 10.1097/sap.0000000000003940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Abdominoplasty may generate an increase in the intra-abdominal pressure (IAP) and consequently an alteration in the pulmonary ventilation. The purpose of this study was to evaluate the potential alterations in the maximal static inspiratory pressure (MIP) and maximal static expiratory pressure (MEP) after abdominoplasty. METHODS Thirty-three female patients, aged between 18 and 60, with type III/B Nahas abdominal deformity that underwent abdominoplasty with plication of the anterior rectus and external oblique aponeurosis were selected. The MIP and MEP were measured using a mouthpiece. This is a simple way to indirectly gauge inspiratory and expiratory muscle strength. Measurements were performed before surgery and on the 2nd, 7th, 15th, and 180th postoperative day. In addition, IAP was measured before abdominoplasty and after the placement of compression garment. The MIP and MEP were compared using analysis of variance, followed by the Bonferroni multiple comparison test pairing the different points in time. Paired Student's t test was used for comparing IAP measurements. Pearson's correlation test was used to compare MIP and MEP variations with IAP variation. Results were considered statistically significant when P ≤ 0.05. RESULTS A decrease was observed in MEP on the 2nd day, with a return close to normal values on the 15th day. In opposition MIP had a surprisingly increase on the 15th postoperative day (129 cmH2O), normalizing 180 days after the operation. A leap in IAP values was revealed at the end of the surgical procedure. It was not possible to establish a positive correlation between the increase of IAP and the alterations of MIP and MEP. CONCLUSIONS There is a decrease in maximum expiratory pressure on the very early postoperative day (2nd postoperative day) and an increase in maximum inspiratory pressure on the 15th postoperative day in patients who underwent abdominoplasty. There was no correlation between the IAP and maximum respiratory pressure variations, both inspiratory and expiratory.
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2
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Nahas FX, Ferreira LM. Management of the Musculoaponeurotic Layer in Abdominoplasty. Clin Plast Surg 2024; 51:59-69. [PMID: 37945076 DOI: 10.1016/j.cps.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Abdominoplasty has evolved in the last few decades, especially the treatment of the myoaponeurotic deformities. Bulging, lack of definition of the abdominal contour, should be understood and treated according to the individual deformity. Many types of deformities have been recognized and treatment respects the local anatomy in most cases. Scientific basis that consolidate these treatments are discussed as well as possible recurrences and pitfalls of these techniques. The histological composition of muscles and fascia are also discussed and anatomical details help to enrich the knowledge of the correction of this layer. Specific types of sutures are suggested for both plications and muscle advancement.
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Affiliation(s)
- Fabio Xerfan Nahas
- Adjunct Professor of Plastic Surgery, Federal University of São Paulo, UNIFESP, EPM, Av. Brasil 275, São Paulo, São Paulo 01431-000, Brazil.
| | - Lydia Masako Ferreira
- Head and Full Professor, Federal University of São Paulo, UNIFESP, EPM, R. Napoleão de Barros, 715 - 4o. andar, São Paulo, São Paulo 04024-002, Brazil
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3
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Gilbert MM, Anderson SR, Abtahi AR. Alternative Abdominal Wall Plication Techniques: A Review of Current Literature. Aesthet Surg J 2023; 43:856-868. [PMID: 37093978 DOI: 10.1093/asj/sjad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023] Open
Abstract
Abdominoplasty is one of the most common procedures performed in plastic surgery. By removing redundant skin and fat tissue, body contouring narrows the waist and achieves a naturally flattened appearance. To achieve this, one technique frequently utilized is plication of the abdominal rectus sheath. Although abdominal wall plication is commonly performed during abdominoplasty, there is a lack of consensus regarding which plication method provides the best outcomes. Each variation addresses some of the common intraoperative and postoperative complications of abdominoplasty. These include extended operating time, rupture of the plication, epigastric bulging, and patient postoperative dissatisfaction. Many plication techniques have been described in the literature, but no single technique has been adopted by plastic surgeons as the gold standard. Here we present a narrative comparison of current published literature reporting novel or modified abdominoplasty plication techniques. This includes diagrams of each procedure, sutures utilized, and key concepts of each plication technique. Discussion regarding how these modifications change operating time, alter epigastric bulging, and improve the ability to narrow the waist is provided. The purpose of this paper is to provide a concise source document for plastic surgeons to reference when choosing a plication method to use during abdominoplasty. LEVEL OF EVIDENCE: 4
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4
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Wang F, Chemakin K, Shamamian P, Punn I, Campbell T, Ricci JA. Rectus Plication Does Not Increase Risk of Thromboembolic Events Following Abdominal Body Contouring: A Matched Case-Control Analysis. Aesthet Surg J 2022; 42:1435-1444. [PMID: 36074733 DOI: 10.1093/asj/sjac195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Rectus abdominis plication increases intra-abdominal pressure and lower-extremity venous stasis, which may increase the incidence of venous thromboembolism (VTE) events. OBJECTIVES The aim of this study was to investigate the potential association between VTE and rectus abdominis muscle plication during surgery. METHODS A retrospective review of all patients who underwent abdominal body contouring at the authors' institution between 2010 and 2020 was completed. Cases were those with postoperative VTEs and were matched to controls (1:4) via potential confounders. Variables collected include demographic data, operative details, comorbidities, and postoperative complications. Statistical analysis was performed with parametric, nonparametric, and multivariable regression modeling. RESULTS Overall, 1198 patients were included; 19 (1.59%) experienced a postoperative VTE and were matched to 76 controls. The overall cohort was 92.7% female with an average age of 44 years, an average Charlson Comorbidity Index of 1 point, and an average BMI of 30.1 kg/m2. History of cerebrovascular events (14.5% vs 36.8%, P = 0.026) differed significantly between cohorts, but no significant associations were noted in all other baseline demographics. Additionally, VTE cases were more likely to have received intraoperative blood transfusions (odds ratio = 8.4, P = 0.04). Bivariate analysis demonstrated cases were significantly more likely to experience concurrent complications, including delayed wound healing (0% vs 5.3%, P = 0.044), seroma formation (5.3% vs 21.1%, P = 0.027), and fat necrosis (0% vs 5.3%, P = 0.044). However, these findings were not significant in a multivariable regression model. Plication was not associated with VTE outcomes. CONCLUSIONS Rectus plication does not increase the risk of VTE. However, the odds of VTE are significantly increased in patients who received intraoperative blood products compared with those who did not. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Fei Wang
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Katherine Chemakin
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Peter Shamamian
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Isha Punn
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Tessa Campbell
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Joseph A Ricci
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
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5
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Martins MRC, Moraes BZFD, Fabri DC, Castro HASD, Rostom L, Ferreira LM, Nahas FX. Do Abdominal Binders Prevent Seroma Formation and Recurrent Diastasis Following Abdominoplasty? Aesthet Surg J 2022; 42:1294-1302. [PMID: 35830484 DOI: 10.1093/asj/sjac194] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND For decades, the postoperative wearing of abdominal binders has been suggested to reduce dead space and prevent mobilization of the musculoaponeurotic layer in an attempt to decrease the risk of seroma formation and recurrent diastasis. OBJECTIVES This study sought to evaluate whether the postoperative wearing of an abdominal binder provides any additional contribution to the reduction of either seroma formation or recurrent diastasis recti when abdominoplasty is performed with quilting sutures. METHODS Thirty-four women undergoing abdominoplasty were randomized into 2 groups: the binder group (n = 16) wore abdominal binders during the postoperative period, whereas the control group (n = 18) did not. Ultrasound examination was performed on postoperative days 7 and 14 to assess seroma formation and at 6 months postoperatively to assess recurrence of diastasis recti. A t test for independent samples was applied to compare means between 2 numeric variables. Generalized estimation equation models were used to evaluate seroma volume at different time points for the 2 groups. RESULTS No significant differences in seroma volume were found between groups on postoperative days 7 (P = 0.830) and 14 (P = 0.882). Seven cases of subclinical recurrent diastasis were observed by ultrasound examination in the supraumbilical (4 cases) and infraumbilical regions (3 cases), but without significant differences (P = 1.000) between the 2 groups. Recurrent diastasis was not detected during physical examinations. CONCLUSIONS The postoperative wearing of abdominal binders was not effective in preventing either seroma formation or recurrent diastasis following abdominoplasty with quilting sutures. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | | | - Daniel Capucci Fabri
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Lucas Rostom
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fabio Xerfan Nahas
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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6
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Martins MRC, Moraes BZFD, Fabri DC, Castro HASD, Rostom L, Ferreira LM, Nahas FX. The Effect of Quilting Sutures on the Tension Required to Advance the Abdominal Flap in Abdominoplasty. Aesthet Surg J 2022; 42:628-634. [PMID: 34791039 DOI: 10.1093/asj/sjab395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Quilting sutures attaching the abdominal flap to the aponeurosis contribute to the prevention of seroma formation following abdominoplasty. The sutures distribute the tension over the subcutaneous tissue along the flap length, theoretically decreasing tension at the distal (cutaneous) end of the flap. This is expected to reduce the risks of necrosis, dehiscence, and enlarged or hypertrophic scars. OBJECTIVES This study sought to verify whether quilting sutures decrease the tension required to advance the dermal-fat flap in abdominoplasty. METHODS Thirty-four women undergoing abdominoplasty with quilting sutures participated in the study. The tensile force required for flap advancement was measured with a digital force gauge before and after placement of quilting sutures and then compared. Differences in tensile force were tested for correlations with BMI, age, weight of flap tissue removed, number of previous pregnancies, and postoperative complications, including seroma formation, hematoma, necrosis, dehiscence, and enlarged or hypertrophic scars. RESULTS A mean reduction in tension of 27.7% was observed at the skin suture after the placement of quilting sutures (P < 0.001). No significant correlation was found between reduced flap tension and BMI, age, weight of tissue removed, or number of births. One case of seroma formation and 2 cases of enlarged scars were observed, but no case of hematoma, necrosis, or wound dehiscence was detected. CONCLUSIONS The use of quilting sutures to attach the abdominal flap to the aponeurosis of the anterior abdominal wall reduced tension at the advancing edge of the flap in abdominoplasty.
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Affiliation(s)
| | | | - Daniel Capucci Fabri
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Lucas Rostom
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fabio Xerfan Nahas
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Keramidas E, Rodopoulou S, Gavala MI. A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study. Aesthetic Plast Surg 2022; 46:2323-2332. [PMID: 35043248 PMCID: PMC9592666 DOI: 10.1007/s00266-021-02739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
Background This study presents a classification system and treatment method to correct Rectus diastasis (RD) during abdominoplasty. Materials and methods One hundred and sixty seven patients undergoing abdominoplasty were enrolled between April 2014 and January 2018. Forty-three patients did not present with RD and were excluded from the analysis. Mean age was 40.32 years, mean BMI was 23.84, and minimum follow-up was 24 months. A four-type (A: mild 2–3cm, B: moderate 3–5cm, C: severe 5–7cm, and D: very severe 7–9cm) classification system is described. A different treatment method is performed in each category using continuous and interrupted absorbable sutures. Postoperatively patients filled up a questionnaire that involved the level of pain, the postoperative day they performed specific indoor/outdoor activities, and the evaluation of the aesthetic result. Results No statistically significant differences were observed between the four RD types regarding pain, complications, and return to specific activities. All types of RD had the same low rate complication profile. The seroma rate was 0.81%. The infection rate was 0.81%, and the thromboembolism and the pneumonic embolism rate was 0%. After 2–6 years of follow-up no clinical recurrence of rectus diastasis was observed. All reoperations (14.52%) were performed due to scar deformities. Mean pain score levels were very low (<1.5) and within a week most patients returned to specific indoor and outdoor activities. Most patients were extremely satisfied with the results. Conclusions In this article, we present an updated classification system and treatment protocol to provide surgeons a safe and standardized method that produces high-quality aesthetic results. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Supplementary Information The online version contains supplementary material available at 10.1007/s00266-021-02739-w.
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Affiliation(s)
- Evangelos Keramidas
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece.
| | - Stavroula Rodopoulou
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece
| | - Maria-Ioanna Gavala
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece
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Olsson A, Kiwanuka O, Wilhelmsson S, Sandblom G, Stackelberg O. Surgical repair of diastasis recti abdominis provides long-term improvement of abdominal core function and quality of life: a 3-year follow-up. BJS Open 2021; 5:6369782. [PMID: 34518875 PMCID: PMC8438255 DOI: 10.1093/bjsopen/zrab085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
Background Diastasis recti abdominis (DRA) is a condition affecting many post-partum women. The aim of this study was to evaluate long-term results of surgical repair of DRA in a cohort of post-partum women. Methods Sixty post-partum women with DRA and training-resistant core dysfunctions were included. Surgical repair was performed with suture plication of the linea alba. Abdominal core function was evaluated with the abdominal trunk function protocol (ATFP) including a self-report questionnaire and seven functional tests. Urinary incontinence and quality of life were evaluated with the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7) and the SF-36 questionnaire. Follow-up was performed at 1 and 3 years after surgery. Results Response rate at the 3-year follow-up was 86.7 per cent for the disability rating index (DRI) questionnaire; and 71.7 per cent for the ATFP, UDI-6, IIQ-7 and SF-36 questionnaires. All DRI parameters were improved (P < 0.001) after 3 years of follow-up compared with preoperative values. The functional tests in the ATFP showed an improvement in core muscle strength and stability (P < 0.001), back muscle strength (P < 0.001) and abdominal muscle strength (P = 0.002) compared to preoperative values as well as an improvement of core muscle strength and stability compared with the 1-year follow-up values (P = 0.003). UDI-6 and IIQ-7 results were improved (P < 0.001 and P = 0.004) compared with preoperative values and showed consistent values compared with the 1-year follow-up (P = 0.09 and P = 1.0). Quality of life measured with SF-36 was improved compared with preoperative values and showed consistent values compared with the 1-year follow-up. Conclusion The functional improvement of surgical reconstruction of the DRA persisted for 3 years in this series of post-partum women with DRA.
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Affiliation(s)
- Anders Olsson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Olivia Kiwanuka
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Sofia Wilhelmsson
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Otto Stackelberg
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden.,Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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9
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Naidu NS. Invited Discussion on: "Safety of a Modified Lipoabdominoplasty Technique for Donor-Site Closure in Abdominal Based Free Flap Breast Reconstruction". Aesthetic Plast Surg 2021; 45:1441-1443. [PMID: 33507349 DOI: 10.1007/s00266-021-02135-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
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10
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Jessen ML, Öberg S, Rosenberg J. Surgical techniques for repair of abdominal rectus diastasis: a scoping review. J Plast Surg Hand Surg 2021; 55:195-201. [PMID: 33502282 DOI: 10.1080/2000656x.2021.1873794] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Rectus diastasis is characterized by widening and laxity of the linea alba, causing the abdominal content to bulge. Rectus diastasis is treated either conservatively with physiotherapy, or surgically, surgical treatment showing especially convincing results. The primary aim of this study was to describe surgical techniques used to correct abdominal rectus diastasis. Secondary, we wished to assess postoperative complications in relation to the various techniques. A systematic scoping review was conducted and reported according to the PRISMA-ScR statement. PubMed, Embase, and Cochrane Library were searched systematically. Studies were included if they described a surgical technique used to repair abdominal rectus diastasis, with or without concomitant ventral hernia. Secondary outcomes were recurrence rate and other complications. A total of 61 studies were included: 46 used an open approach and 15 used a laparoscopic approach for repair of the abdominal rectus diastasis. All the included studies used some sort of plication, but various technical modifications were used. The most common surgical technique was classic low abdominoplasty. The plication was done as either a single or a double layer, most commonly with permanent sutures. There were overall low recurrence rates and other complication rates after both the open and the laparoscopic techniques. We identified many techniques for repair of abdominal rectus diastasis. Recurrence rate and other complication rates were in general low. However, there is a lack of high-level evidence and it is not possible to recommend one method over another. Thus, further randomized controlled trials are needed in this area.
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Affiliation(s)
- Majken Lyhne Jessen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Stina Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
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11
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Soteropulos CE, Edinger KM, Leibl KE, Siebert JW. Improvement in Back Pain Following Abdominoplasty: Results of a 10-Year, Single-Surgeon Series. Aesthet Surg J 2020; 40:1309-1315. [PMID: 32003775 PMCID: PMC7676454 DOI: 10.1093/asj/sjaa032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Few studies have examined the impact of abdominoplasty on chronic back pain. Objectives The aim of this study was to test our hypothesis that patients undergoing abdominoplasty with anterior abdominal wall plication will show significant improvements in back pain and physical function compared with those without plication. Methods We utilized Current Procedural Terminology (CPT) codes to identify patients who underwent abdominoplasty with the senior author over a 10-year period. The Oswestry Disability Index (ODI) and the RAND 36-Item Short-Form Health Survey (SF-36) were administered. All patients indicating preoperative back pain were reviewed. Results Of 338 patients, 143 surveys (42.3%) were returned; 51 patients (35.7%; n = 28 aesthetic, n = 23 massive weight loss) reported preoperative back pain on the ODI. Paired t tests compared overall and strata-specific changes in ODI and SF-36 pre- and postsurgery. Multivariable linear regression models were fitted to model relations between scores and plication, adjusting for presurgery scores and patient variables. There were significant improvements in overall patient cohort in ODI (–15.14), SF-36 physical function (19.92), and pain (17.42) (P < 0.001), as well as when patients were stratified by plication status. However, outcomes between those with plication and those without were not significantly different. Conclusions Abdominoplasty with and without anterior abdominal wall plication significantly improves ODI and SF-36 scores relating to physical function and pain, in both aesthetic and massive weight loss patients. Outcomes did not differ based on plication status. All patients with preoperative back pain showed improvement regardless of operation performed, suggesting that abdominoplasty with or without abdominal wall plication improves chronic back pain in this patient population. Level of Evidence: 4 ![]()
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Affiliation(s)
- Carol E Soteropulos
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kylie M Edinger
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kayla E Leibl
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - John W Siebert
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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12
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Nahas FX. Commentary on: Improvement in Back Pain Following Abdominoplasty: Results of a 10-Year, Single-Surgeon Series. Aesthet Surg J 2020; 40:1316-1318. [PMID: 32281616 DOI: 10.1093/asj/sjaa063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fábio Xerfan Nahas
- Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil
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13
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Pajula S, Gissler M, Kaijomaa M, Jyränki J, Tukiainen E, Koljonen V. Pregnancy and delivery after lower body contouring surgery is safe for the mother and child. J Plast Reconstr Aesthet Surg 2020; 74:143-151. [PMID: 32859569 DOI: 10.1016/j.bjps.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/18/2020] [Accepted: 08/01/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Obesity in fertile age women has increased worldwide leading to increased bariatric procedures. Lower body contouring surgery (LBCS) is one of the most commonly performed esthetic operations, mainly owing to massive weight loss. However, there is a paucity of data regarding pregnancy and delivery after LBCS. In this study, we examined whether LBCS influences pregnancy or delivery and mother and baby outcome. METHODS In this national registry-based study, we used data from the Finnish Institute of Health and Welfare and the Causes of Death registry. We included fertile age women, from 18 to 54 years who had LBCS with or without a bariatric procedure and who experienced pregnancy and delivery were compared to all deliveries in Finland during 1999- 2016. RESULTS We identified 92 women who had LBCS before delivery. These 92 women had planned cesarean sections more often (P < .001) and preterm delivery was more common (P < .001). None of the mothers or babies died. Of the 92 women, 26 had a preceding bariatric procedure. The preceding bariatric procedures did not increase the risk for preterm delivery or low birth weight. The need for urgent or emergency sections was not increased. The heightened number of planned cesareans is caused by the different demographics of the study group, indicating that previous LBCS is not a contraindication for vaginal delivery. CONCLUSION Pregnancy and delivery are safe for the mother and the baby after LBCS. The possible deviations from normal pregnancy and delivery should be discussed with fertile age women seeking LBCS.
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Affiliation(s)
- Susanna Pajula
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland; Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | - Marja Kaijomaa
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Janne Jyränki
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Virve Koljonen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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14
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Mittal P, Heuft T, Richter DF, Wiedner M. Venous Thromboembolism (VTE) Prophylaxis After Abdominoplasty and Liposuction: A Review of the Literature. Aesthetic Plast Surg 2020; 44:473-482. [PMID: 31858207 DOI: 10.1007/s00266-019-01576-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this review article was to study recent articles and summarise the guidelines, indications, risks and benefits of using VTE prophylaxis in patients undergoing abdominoplasty and liposuction. METHODS A search of PubMed was performed using selected keywords related to the topic. Based on the inclusion and exclusion criteria, a total of 25 articles were included in the review. RESULTS Abdominoplasty has the highest occurrence of VTE among aesthetic procedures. A higher incidence of VTE was noted when abdominoplasty was combined with liposuction. Circumferential procedures, obesity and HRT (hormone replacement therapy) were found to be independent risk factors for VTE. The 2005 Caprini/Davison risk assessment model is the most appropriate model for risk stratification in plastic surgery patients. Newer oral anticoagulants hold promise. CONCLUSIONS Preoperative risk stratification should be performed for all patients. Chemoprophylaxis should be considered in cases with a Caprini RAM score > 7 or in those with independent risk factors. Administering regional blocks for anaesthesia and avoiding full muscle paralysis help reduce the risk of VTE. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Nahas FX, Faustino LD, Ferreira LM. Abdominal Wall Plication and Correction of Deformities of the Myoaponeurotic Layer: Focusing on Materials and Techniques Used for Synthesis. Aesthet Surg J 2019; 39:S78-S84. [PMID: 30869750 DOI: 10.1093/asj/sjy333] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The different types of sutures utilized in plications and for correction of diastasis during abdominoplasty are reviewed and discussed. Because correction of abdominal deformities also involves fascia and muscle advancement, this review also covers the suture materials used in muscle advancement. The selection of specific techniques to treat different types of abdominal wall deformity is also considered. This is important, because the outcome when correcting these deformities depends not only on suture materials but also on employing the optimum technique. A PubMed/Medline search was performed with the following search terms: rectus diastasis, diastasis recti, diastasis recti abdominis, correction of rectus diastasis, abdominoplasty. Relevant articles identifying the type of suture (rapidly absorbable, slowly absorbable, nonabsorbable), monofilament or multifilament sutures, antibiotic-coated sutures, and barbed sutures were evaluated. In addition, articles about surgical technique comparing continuous and interrupted sutures, in both the anterior and posterior aponeurosis, to correct rectus diastasis are discussed. Efficacy of suture materials was evaluated based on the long-term results and recurrence rates reported in these articles. The current literature provides sufficient data to recommend a single-layer continuous suture, with slowly absorbable sutures of 0 polydioxanone or 2-0 nylon, for correction of abdominal diastasis. An interrupted triangular suture is a good alternative to correct the vertical elongation of the myoaponeurotic layer that occurs after pregnancy.
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Affiliation(s)
- Fábio Xerfan Nahas
- Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Leandro Dario Faustino
- Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo, São Paulo, Brazil
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Doubkova L, Andel R, Palascakova-Springrova I, Kolar P, Kriz J, Kobesova A. Diastasis of rectus abdominis muscles in low back pain patients. J Back Musculoskelet Rehabil 2018; 31:107-112. [PMID: 28946525 DOI: 10.3233/bmr-169687] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abdominal muscles are important spinal stabilizers and its poor coordination, as seen in diastasis of rectus abdominis (DRA), may contribute to chronic low back pain (LBP). However, this has not yet been studied directly. OBJECTIVES To conduct a pilot study to examine the association between DRA and LBP. METHODS Using a digital caliper, standard clinical DRA measurement was performed in 55 participants with and 54 without chronic LBP. RESULTS Participants were on average 55 years old, 69 (63%) were women. Among the 16 participants with DRA, 11 (69%) had chronic LBP; among the 93 participants without DRA, 44 (47%) had LBP. Among men, 7 of 9 (77%) with DRA had LBP and 14 of 31 (45%) without DRA had LBP. Among women, 4 of 7 (57%) with DRA had LBP and 30 of 62 (48%) without DRA had LBP. BMI was the strongest correlate of DRA and may explain the relation between DRA and chronic LBP. CONCLUSIONS DRA and LBP may be interrelated, especially among men. This may be a function of greater BMI in individuals with chronic LBP. Understanding the association between DRA, LBP, and BMI may have important implications for treatment of LBP and for intervention.
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Affiliation(s)
- Lucie Doubkova
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ross Andel
- School of Aging Studies, University of South Florida, Tampa, FL, USA.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | | | - Pavel Kolar
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jiri Kriz
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Alena Kobesova
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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Nahas FX. Commentary on: The Retro-Rectus Prosthesis for Core Myofascial Restoration in Cosmetic Abdominoplasty. Aesthet Surg J 2017; 37:939-941. [PMID: 28398540 DOI: 10.1093/asj/sjx057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fabio Xerfan Nahas
- Dr Nahas is an Affiliate Professor, Division of Plastic Surgery, Department of Surgery, UNIFESP, São Paulo, Brazil
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Gama LJM, Barbosa MVJ, Czapkowski A, Ajzen S, Ferreira LM, Nahas FX. Single-Layer Plication for Repair of Diastasis Recti: The Most Rapid and Efficient Technique. Aesthet Surg J 2017; 37:698-705. [PMID: 28333252 DOI: 10.1093/asj/sjw263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Plication of the anterior rectus sheath is the most commonly used technique for repair of diastasis recti, but is also a time-consuming procedure. Objectives The aim of this study was to compare the efficacy and time required to repair diastasis recti using different plication techniques. Methods Thirty women with similar abdominal deformities, who had had at least one pregnancy, were randomized into three groups to undergo abdominoplasty. Plication of the anterior rectus sheath was performed in two layers with 2-0 monofilament nylon suture (control group) or in a single layer with either a continuous 2-0 monofilament nylon suture (group I) or using a continuous barbed suture (group II). Operative time was recorded. All patients underwent ultrasound examination preoperatively and at 3 weeks and 6 months postoperatively to monitor for diastasis recurrence. The force required to bring the anterior rectus sheath to the midline was measured at the supraumbilical and infraumbilical levels. Results Patient age ranged from 26 to 50 years and body mass index from 20.56 to 29.17 kg/m2. A significant difference in mean operative time was found between the control and study groups (control group, 35 min:22 s; group I, 14 min:22 s; group II, 15 min:23 s; P < 0.001). Three patients in group II had recurrence of diastasis. There were no significant within- and between-group differences in tensile force on the aponeurosis. Conclusions Plication of the anterior rectus sheath in a single-layer with a continuous suture showed to be an efficient and rapid technique for repair of diastasis recti. Level of Evidence 1
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Affiliation(s)
| | | | - Adriano Czapkowski
- Clinical Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sergio Ajzen
- Department of Diagnostic Imaging, UNIFESP, São Paulo, Brazil
| | | | - Fábio Xerfan Nahas
- Division of Plastic Surgery, Department of Surgery, UNIFESP, São Paulo, Brazil
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Nahas FX. Commentary on: Zones of Adhesion of the Abdomen: Implications for Abdominoplasty. Aesthet Surg J 2017; 37:200-202. [PMID: 27821415 DOI: 10.1093/asj/sjw177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabio Xerfan Nahas
- Dr Nahas is an Adjunct Professor, Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil.
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Wilhelmsson S, Fagevik Olsén M, Staalesen T, Elander A, 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 2016; 51:199-204. [DOI: 10.1080/2000656x.2016.1222293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Sofia Wilhelmsson
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Monika Fagevik Olsén
- Department of Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Trude Staalesen
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Malin Nygren-Bonnier
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
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Pereira N, Sciaraffia C, Danilla S, Parada F, Asfora C, Moral C. Effects of Abdominoplasty on Intra-Abdominal Pressure and Pulmonary Function. Aesthet Surg J 2016; 36:697-702. [PMID: 26895955 DOI: 10.1093/asj/sjv273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Abdominal wall weakness is a consequence of rectus abdominis diastasis and flaccidity of the myofascial component. A degree of plicature of the rectus abdominis generates an increase of intra-abdominal pressure (IAP), which may result in an increase of intrathoracic pressure, thus affecting thoracic hemodynamics and leading to inadequate ventilation. OBJECTIVES To assess changes generated by plicature of the rectus abdominis on IAP and pulmonary function in patients undergoing abdominoplasty. METHODS A total of 10 female patients with abdominal ptosis were included. Chronic smokers and patients with respiratory co-morbidities were excluded. The IAP was measured using a modified Kron's trans-bladder technique. Pulmonary function was assessed by pulmonary compliance (P-Comp) and was calculated with parameters provided by the mechanical ventilator. Both were calculated before and after plicature. RESULTS The mean values for IAP before and after plicature were 6.6 and 9.3 mmHg respectively. Before plicature, the mean P-Comp value was 38.97 mL/cm of water, and after it was 36.54 mL/cm. Both differences were statistically significant. CONCLUSIONS Based on the results obtained, it is possible to conclude that plicature of the rectus abdominis generates significant physiological changes, such as an increase in IAP and a decrease of P-Comp, which do not have a clinically relevant impact on healthy individuals. Measuring IAP with the modified technique and the assessment of pulmonary function using P-Comp are both reliable and provide a more accurate correlation with such physiologic changes. LEVEL OF EVIDENCE 3: Therapeutic.
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Affiliation(s)
- Nicolas Pereira
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carlos Sciaraffia
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Stefan Danilla
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Francisco Parada
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Constanza Asfora
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - César Moral
- Dr Pereira is a Plastic Surgeon, Plastic Surgery and Burns Department, Hospital del Trabajador; Plastic Surgery Department, Clínica Las Condes, Santiago, Chile; and Clínica Universidad de Chile, Santiago, Chile. Dr Sciaraffia is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile; and Subdirector, Oficina de Apoyo a la Investigación Clínica (OAIC), Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Danilla is a Plastic Surgeon, Department of Surgery, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Parada is a Plastic Surgeon, Clínica Universidad de Chile, Santiago, Chile. Ms Asfora is an Operating Room Midwife, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile. Dr Moral is an Anesthesiologist, Department of Anesthesiology, Hospital Clínico Universidad de Chile, Santiago, Chile
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Nahas FX. Commentary on: Improvements in Vertebral-Column Angles and Psychological Metrics After Abdominoplasty with Rectus Plication. Aesthet Surg J 2016; 36:588-90. [PMID: 26931307 DOI: 10.1093/asj/sjw028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Fabio Xerfan Nahas
- Dr Nahas is an Adjunct Professor, Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil
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Temel M, Türkmen A, Berberoğlu Ö. Improvements in Vertebral-Column Angles and Psychological Metrics After Abdominoplasty With Rectus Plication. Aesthet Surg J 2016; 36:577-87. [PMID: 26764262 DOI: 10.1093/asj/sjv257] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 12/01/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Substantial fluctuations in body weight can result in diastasis recti and weakening of the connections between the lateral abdominal muscles and the rectus sheath. OBJECTIVES The authors sought to determine the postural and psychological effects of abdominoplasty with vertical rectus plication. METHODS Forty women with substantial back and lumbar pain owing to abdominal lipodystrophy were evaluated in a prospective study. Preoperatively and 6 months postoperatively, patients underwent bidirectional radiography of the thoracic and lumbar regions. A visual analog scale (VAS), the Beck Depression Inventory (BDI), and the Nottingham Health Profile (NHP) were applied to assess physical, psychological, and quality-of-life changes following surgery. RESULTS Significant improvements in posture, assessed in terms of lumbar lordosis, thoracic kyphosis, and the lumbosacral angle, were observed 6 months after abdominoplasty with rectus plication. Results of the VAS and BDI indicated significant improvements in pain and quality of life, respectively. Results of the NHP indicated significant postoperative improvements in fatigue, pain, and sleep. CONCLUSIONS Abdominoplasty with rectus plication improves posture by tightening the thoracolumbar fascia. In selected patients, abdominoplasty can reduce back and lumbar pain, thereby improving quality of life.
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Affiliation(s)
- Metin Temel
- Dr Temel is a Clinical Assistant Professor, Division of Plastic Surgery, Mustafa Kemal University, Hatay, Turkey. Dr Türkmen is a Clinical Associate Professor, Division of Plastic Surgery, İstanbul University, İstanbul, Turkey. Dr Berberoğlu is a Plastic Surgeon in private practice in Gaziantep, Turkey
| | - Arif Türkmen
- Dr Temel is a Clinical Assistant Professor, Division of Plastic Surgery, Mustafa Kemal University, Hatay, Turkey. Dr Türkmen is a Clinical Associate Professor, Division of Plastic Surgery, İstanbul University, İstanbul, Turkey. Dr Berberoğlu is a Plastic Surgeon in private practice in Gaziantep, Turkey
| | - Ömer Berberoğlu
- Dr Temel is a Clinical Assistant Professor, Division of Plastic Surgery, Mustafa Kemal University, Hatay, Turkey. Dr Türkmen is a Clinical Associate Professor, Division of Plastic Surgery, İstanbul University, İstanbul, Turkey. Dr Berberoğlu is a Plastic Surgeon in private practice in Gaziantep, Turkey
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