Title: Sensibility of The Abdomen After Abdominoplasty



Title: Long Term Follow-up Of Correction Of Rectus Diastasis

Authors: Fabio X. Nahas, MD, PhD, Julio Dieguez, MD, Marcus Vinícius Barbosa, MD

Correction of rectus diastasis (RD) is a procedure performed by most surgeons during abdominoplasty. However, literature search demonstrated that there were no prospective studies that showed the stability of this procedure after several years. The purpose of this paper is to verify the long-term efficacy of the correction of RD when plication of the anterior rectus sheath is performed.

Method: Twenty-four female patients who underwent abdominoplasty were studied. All patients had had at least one previous pregnancy. Their ages ranged from 18 to 52 years. RD was measured preoperatively with two CT-scan slices: 3 cm above (superior level) and 2 cm below the umbilicus (inferior level). The bony levels where the slices were made served as a reference for the postoperative CT-scans. In all patients Pancuron was used to achieve muscle relaxation. The initial dose was 0.3 mg/kg of body weight and 0.15 mg/kg per hour was used for maintenance. During the operation, RD was measured at the same levels of the preoperative CT-scan slices. After the complete exposure of the aponeurotic layer, the necessary force to bring the medial edges of the rectus muscles to the midline was measured with a dynamometer on the two levels studied. Plication of the anterior rectus sheath was performed on two layers with 2-0 Nylon: the first layer was made with interrupted buried stitches 0.4 cm from each other and the second layer was a continuous suture. Postoperative CT-scans were made at 3 weeks and 6 months after the operation. A long-term follow-up CT-scan was made from 32 to 84 months (average of 61 months) after the operation on every patient.

Statistical Analysis: Student’s ”t” test was used to compare the values of rectus diastasis obtained with the preoperative Ct-scan and the actual values of diastasis found during surgery.

Results: There was no statistical significant difference when the values of RD measured with CT-scan were compared to those found during the operation (Table 1).

There was a wide range of resistance to traction of the rectus edges to the midline (Table 2).

The 3-week postoperative CT-scan proved that the correction of RD was achieved by the procedure. The long term CT-scans, - performed, in average, 61 months after the operation - showed that there was no recurrence of RD in any patient of this series (Figures 1 and 2).

Conclusions: CT-scan is a very reliable method to verify the position of the abdominal muscles. Most importantly, this study demonstrates that, although there was a wide range of individual tension of the myoaponeurotic layer, the plication of the anterior rectus sheath is a long-lasting procedure to correct rectus diastasis.

Table 1 - Average and Standard Deviation of the width of rectus diastasis on preoperative CT-scan and intra-operative finding. (n=20)

| |Superior Level |Inferior Level |

| |Pre-op CT-scan |Intra-op |Pre-op CT-scan |Intra-op |

|Average RD (cm) |2.4 ( 1.5 |2.7 ( 0.9 |1.4 ( 0.5 |1.6 ( 0.5 |

|t value |0.7059 |1.6506 |

|p |P = 0.323* |P = 0.110* |

Where: RD – Rectus Diastasis

* non significant statistical difference (Student “t” test)

Table 2 – Minimum and maximum traction to bring the medial edges of the rectus muscles to the midline on both levels

| |Minimum Traction |Maximum Traction |

| |(gf) |(gf) |

|Superior Level |200 |1500 |

|Inferior Level |100 |1000 |

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1A 1B

Figure 1A – Preoperative CT-scan slice on the superior level, showing a 3.5 cm rectus diastasis. 2A – Five year postoperative CT-scan demonstrating the recti muscles edge together in the midline. Note that both slices were made at the same bone level.

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2A 2B

Figure 2A– Preoperative CT-scan slice on the inferior level, showing a 2 cm rectus diastasis. 2A – Five year postoperative CT-scan demonstrating total correction of the diastasis. Note that both slices were made at the same bone level.

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