Relationship between Preoperative Abdominal Wall Strength and Bulging at the Abdominal Free Flap Donor Site for Breast Reconstruction.

BACKGROUND: Abdominal bulging at the donor site of free abdominal flaps for breast reconstruction is a common postoperative complication. In addition to the thickness of abdominal muscles, the authors identified the rectus abdominis diastasis as an important factor that compromises abdominal wall strength. This study aimed to assess the relationship between preoperative abdominal wall strength and postoperative abdominal bulging. METHODS: A total of 224 patients were enrolled in this study. Patient demographics, the rectus and lateral abdominis muscle thicknesses, and the rate of rectus abdominis diastasis were compared (with versus without bulging). Muscle thickness and rectus abdominis diastasis were investigated by preoperative computed tomography. RESULTS: The group with bulging consisted of 32 patients (14.3 percent), whereas the group without bulging consisted of 192 patients. The group with bulging had a significantly higher gestational history rate. The thickness of the rectus abdominis muscle in the group with bulging was significantly thinner (median, 8.6 mm versus 10.5 mm; p < 0.001) and the rate of rectus abdominis diastasis was significantly higher (78.1 percent versus 32.3 percent; p < 0.001). There were no significant differences with respect to the thickness of the lateral abdominal muscle and the other factors (i.e., age, body mass index, history of laparotomy. and operative details). CONCLUSIONS: Because the diagnosis of abdominal bulging was based on severity, the rate may be high compared to that reported from previous studies. Because the factor of gestational history correlated to thickness of the rectus abdominis muscle and rectus abdominis diastasis, this factor influenced the occurrence of abdominal bulging. Patients with a thin rectus abdominis muscle and rectus abdominis diastasis were at higher risk of abdominal bulging. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare pelvic floor muscle strength (PFMS) and the prevalence of urinary incontinence (UI) and pelvic organ prolapse(POP) in women with and without diastasis recti abdominis (DRA) at 6-8 weeks postpartum. METHODS: Three hundred and ten women underwent routine examinations, including POP quantification (POP-Q), PFMS measurement, DRA evaluation, and UI determination. Chi-squared tests and independent sample t test were used to compare the differences between women with DRA and without DRA. RESULTS: Women with DRA presented significantly lower prepregnancy body mass index (BMI), predelivery BMI, and postpartum BMI; greater gestational age; and higher birth weights than women without DRA(p < 0.05). Moreover, DRA incidence was significantly higher in those who underwent cesarean section (CS) than in those who underwent vaginal delivery (VD)(p = 0.045). Although the PFMS of the DRA group was weaker and the prevalence of UI and POP was slightly higher than those of the no DRA group, the results were not statistically significant. The PFMS of the CS group was stronger than that of the VD group. Urinary incontinence and prolapse incidence were higher in the VD group than in the CS group. Women who underwent CS had a shorter genital hiatus (Gh) and smaller Ba and Bp values than those in the VD group. Women without DRA had an increased chance of Bp ≥ -2 and Gh ≥ 3(p < 0.05). CONCLUSIONS: Women with DRA were not more likely to have weakened PFMS and increased UI or POP at 6-8 weeks postpartum.

The Suprapubic Dermoadipose Flap for Aesthetic Reshaping of the Postpregnancy Abdomen.

BACKGROUND: Postpregnancy full-length diastasis of the recti abdominis muscles is a common condition occasionally associated with atrophy of the subcutaneous fat located at the midline above and below the umbilicus. OBJECTIVES: The authors report a preliminary clinical experience with the suprapubic flap to prevent the late postoperative contour deformities of the postpregnancy abdomen. METHODS: Between January 2005 and January 2015, all female patients undergoing abdominoplasty with the suprapubic flap were included in the present study. Electronic clinical records were reviewed to analyze the patients' ages, body mass index (BMI) scores, pregnancies, risk factors, and operative times, followed by a telephone-based survey to measure patient satisfaction. RESULTS: Twenty-two patients were included. Their ages ranged from 19 to 36 years (mean, 27 years) and their BMI ranged from 17.5 to 22.5 kg/m2 (mean, 20.5 kg/m2). Postoperative follow up ranged from 12 months to 10 years (mean, 89 months). All patients had experienced at least one pregnancy and many of them multiple or twin pregnancies. Umbilical hernias were present in 18 patients. There were 5 unusual cases: one hematoma, one seroma, and three cases of hypertrophic scarring. Thirteen additional minutes were required, on average, to associate the flap. All patients were satisfied or very satisfied with the results. CONCLUSIONS: The suprapubic dermoadipose flap is an effective option to prevent the midline depression that would otherwise remain on the hypogastric region of postpregnant slim women with midline fat tissue atrophy.

Drainless Abdominoplasty Using Barbed Progressive Tension Sutures.

We describe our current technique of drainless abdominoplasty using barbed progressive tension sutures. The perioperative management and detailed steps of procedure are outlined, including indications for concomitantly performing liposuction and repair of diastasis of the rectus abdominis muscles. This approach reliably improves abdominal contour, minimizes complications, and is straightforward to learn and perform.

Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures.

BACKGROUND: The primary aim of this prospective, randomized, clinical, 2-armed trial was to evaluate the risk for recurrence using 2 different operative techniques for repair of abdominal rectus diastasis. Secondary aims were comparison of pain, abdominal muscle strength, and quality of life and to compare those outcomes to a control group receiving physical training only. METHODS: Eighty-six patients were enrolled. Twenty-nine patients were allocated to retromuscular polypropylene mesh and 27 to double-row plication with Quill technology. Thirty-two patients participated in a 3-month training program. Diastasis was evaluated with computed tomography scan and clinically. Pain was assessed using the ventral hernia pain questionnaire, a quality-of-life survey, SF-36, and abdominal muscle strength using the Biodex System-4. RESULTS: One early recurrence occurred in the Quill group, 2 encapsulated seromas in the mesh group, and 3 in the suture group. Significant improvements in perceived pain, the ventral hernia pain questionnaire, and quality of life appeared at the 1-year follow-up with no difference between the 2 operative groups. Significant muscular improvement was obtained in all groups (Biodex System-4). Patient perceived gain in muscle strength assessed with a visual analog scale improved similarly in both operative groups. This improvement was significantly greater than that seen in the training group. Patients in the training group still experienced bodily pain at follow-up. CONCLUSION: There was no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate 1 year after operation. An operation improves functional ability and quality of life. Training strengthens the abdominal muscles, but patients still experience discomfort and pain.