The Normal Width of the Linea Alba in Nulliparous Women

ArticleinClinical Anatomy 22(6):706-11 · September 2009with 477 Reads
DOI: 10.1002/ca.20836 · Source: PubMed
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Abstract
The function of the linea alba is to maintain the abdominal muscles at a certain proximity to each other. In the case of long-lasting increased intra-abdominal pressure, the linea alba widens. Yet, as the existence of the linea a priori implicates a physiological distance between the two rectus muscles, the question arises as to what the normal width of the linea alba is. To evaluate the normal width of the linea alba, we examined 150 nulliparous women between 20 and 45 years of age with a body mass index < 30 kg m(-2) by ultrasound at three reference points: the origin at the xiphoid and 3 cm above and 2 cm below the umbilicus. The examination revealed a broad range of widths at the three reference points. The linea was widest at 3 cm above the umbilicus (-35 mm), followed by the reference point 2 cm below the umbilicus (-31 mm) and the origin at the xiphoid (-31 mm). The mean width was 7 +/- 5 mm at the xiphoid and 13 +/- 7 mm above and 8 +/- 6 mm below the umbilicus. For the definition of the normal width of the linea, the 10th and 90th percentiles were taken. The linea alba can be considered "normal" up to a width of 15 mm at the xiphoid, up to 22 mm at the reference point 3 cm above the umbilicus and up to 16 mm at the reference point 2 cm below the umbilicus in nulliparous women.

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    Diastasis of the rectus is deined as the separation of the midline or alba line, which originates in a laxity of the interlocking ibers from the aponeurosis of both rectus muscles. At present, its surgical correction continues to be discussed. However, there is a multiplicity of factors that justify it.
  • Article
    Study design: Controlled laboratory study. Background: Inter-recti distance (IRD) is the measurement of the linear distance between the medial aspects of the rectus abdominis muscle. Inter-recti distance has been reported to decrease in postpartum women during a curl-up maneuver. Objective: To determine if IRD decreases with active abdominal contraction in men and in nulliparous and parous women. Methods: Fifty-six subjects (male, 11; nulliparous female, 22; parous female, 23) participated. Inter-recti distance was measured with the abdominal muscles at rest and during active contraction (curl-up), at 2 locations (above and below the umbilicus), using ultrasound imaging. A mixed-model, repeated-measures analysis of covariance was used for each of the 2 locations, to determine whether IRD differed between contraction states among the 3 groups, with age and umbilicus circumference as covariates. When significant differences were found, planned t test comparisons were made. Results: The parous group's IRD significantly decreased from rest to contraction at both locations, whereas the nulliparous and male groups' IRD did not significantly change from rest to contraction. The nulliparous group's IRD was significantly narrower than the other groups at rest at both locations, and narrower than the parous group during active contraction. Conclusion: Parous women had a narrower IRD in the curl-up condition than at rest, as hypothesized. However, an unexpected finding of a lack of significant within-group change in IRD in nulliparous women and men occurred. Findings suggest that the IRD in men may only differ from that of nulliparous women.
  • Chapter
    Correct human posture consists of musculoskeletal system balance which protects body structures from injury and progressive deformities. The body segments are balanced in the position of least strain and maximum support. The authors discuss anatomic consideration in posture balance, body image, self-esteem and quality of life, anatomic consideration in abdominoplasty, abdominal wall deformity classifications, the body-contouring operations, abdominoplasty techniques and liposuction, and management of complications. Abdominal-contouring surgery greatly improves functional status of the massive weight loss patient, especially in patients with a higher body mass index at the time of surgery.
  • Article
    Full-text available
    Study design: Longitudinal descriptive exploratory study. Objectives: To evaluate in primigravid women the immediate effect of drawing-in and abdominal crunch exercises on inter-rectus distance (IRD), measured at 4 time points during pregnancy and in the postpartum period. Background: There is scant knowledge of the effect of different abdominal exercises on IRD in pregnant and postpartum women. Methods: The study included 84 primiparous participants. Ultrasound images were recorded with a 12-MHz linear transducer, at rest and during abdominal drawing-in and abdominal crunch exercises, at 3 locations on the linea alba. The IRD was measured at 4 time points: gestational weeks 35 to 41, 6 to 8 weeks postpartum, 12 to 14 weeks postpartum, and 24 to 26 weeks postpartum. Separate 2-way, repeated-measures analyses of variance (ANOVAs) were performed for each exercise (drawing-in and abdominal crunch) and each measurement location to evaluate the immediate effects of exercises on IRD at each of the 4 time points. Similarly, 2-way ANOVAs were used to contrast the effects of the 2 exercises on IRD. Results: Performing the drawing-in exercise caused a significant change in width of the IRD at 2 cm below the umbilicus, narrowing the IRD by a mean of 3.8 mm (95% confidence interval [CI]: 1.2, 6.4 mm) at gestational weeks 35 to 41, and widening the IRD by 3.0 mm (95% CI: 1.4, 4.6 mm) at 6 to 8 weeks postpartum, by 1.8 mm (95% CI: 0.6, 3.1 mm) at 12 to 14 weeks postpartum, and by 2.5 mm (95% CI: 1.4, 3.6 mm) at 24 to 26 weeks postpartum (P<.01). Performing the abdominal crunch exercise led to a significant narrowing of the IRD (P<.01) in all 3 locations at all 4 time points, with the exception of 2 cm below the umbilicus at postpartum weeks 24 to 26. The average amount of narrowing varied from 1.6 to 20.9 mm, based on time and location. Conclusion: Overall, there was a contrasting effect of the 2 exercises, with the abdominal crunch exercise consistently producing a significant narrowing of the IRD. In contrast, the drawing-in exercise generally led to a small widening of the IRD.
  • Article
    Background: The aim of this study was to define the indicators predicting improved abdominal wall function after surgical repair of abdominal rectus diastasis (ARD). Preoperative subjective assessment quantified by the validated Ventral Hernia Pain Questionnaire (VHPQ) was related to relative postoperative functional improvement in abdominal muscle strength. Methods: Fifty-seven patients undergoing surgery for ARD completed the VHPQ before surgery. Preoperative pain assessment results were compared with the relative improvement in muscle strength measured with the BioDex system 4. Results: There was a correlation between the relative improvement in muscle strength measured by the BioDex System 4 for flexion at 30 degrees (P = 0.046) and 60 degrees per second (P = 0.004) and the preoperative question, “Do you find it painful to sit for more than 30 minutes?” There was also a correlation between BioDex improvement for flexion at 30 degrees (P = 0.022) and for isometric work load (P = 0.038) and the preoperative question, “Has abdominal pain limited your ability to perform sports activities?” The VHPQ responses also formed a pattern with a fairly good correlation between other BioDex modalities (with the exception of extension at 60 degrees per second) and the response to the question regarding complaints when performing sports. Postoperative visual analog scale ratings of abdominal wall stability correlated to the questions regarding complaints when sitting (P = 0.040) and standing (P = 0.047). No other correlation was seen. Conclusion: VHPQ ratings concerning pain while being seated for more than 30 minutes and pain limiting the ability to perform sports are promising indicators in the identification of patients likely to benefit from surgical correction of their ARD.
  • Chapter
    The etiology, diagnosis, and management of diastasis recti is now well understood and has demonstrated predictable and reproducible success. Multiparous women are at highest risk for developing diastasis recti. Diagnosis is easily made by clinical examination and symptomology and characterized by a midline abdominal bulge without a fascial defect. Classification systems have been proposed and based on the degree of rectus abdominis separation and myofascial deformity. Management options vary and will depend on the degree of separation between the rectus abdominis muscles. Simple plication has been effective for mild to moderate diastasis. The use of resorbable or nonresorbable mesh places as an onlay or in the retrorectus space has been effective for moderate-to-severe diastasis. The use of laparoscopic or endoscopic techniques can also be considered in select situations.
  • Chapter
    Abdominal wall surgery in the modern era has grown significantly in terms of complexity, with advancements in both technology and surgical technique. A thorough comprehension of clinical anatomy and physiology of the abdominal wall remains of paramount importance in the successful repair of ventral hernias and more for complex reconstructions. The abdominal wall comprises multiple layers including skin, subcutaneous tissue, fascia, muscle, and peritoneum. Each component plays a distinct role in the function of this anatomic unit. This chapter serves to review the basic anatomy and neurovascular supply of the abdominal wall, with attention to more subtle clinical findings and their implications for hernia repair and restoration of the linea alba.
  • Article
    Full-text available
    Purpose: To investigate the interrater reliability of inter-rectus distance (IRD) measured from ultrasound images acquired at rest and during a head-lift task in parous women and to establish the standard error of measurement (SEM) and minimal detectable change (MDC) between two raters. Methods: Two physiotherapists independently acquired ultrasound images of the anterior abdominal wall from 17 parous women and measured IRD at four locations along the linea alba: at the superior border of the umbilicus, at 3 cm and 5 cm above the superior border of the umbilicus, and at 3 cm below the inferior border of the umbilicus. The interrater reliability of the IRD measurements was determined using intra-class correlation coefficients (ICCs). Bland-Altman analyses were used to detect bias between the raters, and SEM and MDC values were established for each measurement site. Results: When the two raters performed their own image acquisition and processing, ICCs(3,5)ranged from 0.72 to 0.91 at rest and from 0.63 to 0.96 during head lift, depending on the anatomical measurement site. Bland-Altman analyses revealed no systematic bias between the raters. SEM values ranged from 0.23 cm to 0.71 cm, and MDC values ranged from 0.64 cm to 1.97 cm. Conclusion: When using ultrasound imaging to measure IRD in women, it is acceptable for different therapists to compare IRDs between patients and within patients over time if IRD is measured above or below the umbilicus. Interrater reliability of IRD measurement is poorest at the level of the superior border of the umbilicus.
  • Article
    Fisheye STUDY DESIGN: Cross-sectional repeated measures. Fisheye BACKGROUND: Rehabilitation of diastasis rectus abdominis (DRA) generally aims to reduce the inter-rectus distance (IRD). We tested the hypothesis that activation of the transversus abdominis (TrA) before a curl-up would reduce IRD narrowing, with less linea alba (LA) distortion/deformation, which may allow better force transfer between sides of the abdominal wall. Fisheye OBJECTIVES: This study investigated behavior of the LA and IRD during curl-ups performed naturally and with preactivation of the TrA. Fisheye METHODS: Curl-ups were performed by 26 women with DRA and 17 healthy control participants using a natural strategy (automatic curl-up) and with TrA preactivation (TrA curl-up). Ultrasound images were recorded at 2 points above the umbilicus (U point and UX point). Ultrasound measures of IRD and a novel measure of LA distortion (distortion index: average deviation of the LA from the shortest path between the recti) were compared between 3 tasks (rest, automatic curl-up, TrA curl-up), between groups, and between measurement points (analysis of variance). Fisheye RESULTS: Automatic curl-up by women with DRA narrowed the IRD from resting values (mean U-point between-task difference, -1.19 cm; 95% confidence interval [CI]: -1.45, -0.93; P<.001 and mean UX-point between-task difference, -0.51 cm; 95% CI: -0.69, -0.34; P<.001), but LA distortion increased (mean U-point between-task difference, 0.018; 95% CI: 0.0003, 0.041; P = .046 and mean UX-point between-task difference, 0.025; 95% CI: 0.004, 0.045; P = .02). Although TrA curl-up induced no narrowing or less IRD narrowing than automatic curl-up (mean U-point difference between TrA curl-up versus rest, -0.56 cm; 95% CI: -0.82, -0.31; P<.001 and mean UX-point between-task difference, 0.02 cm; 95% CI: -0.22, 0.19; P = .86), LA distortion was less (mean U-point between-task difference, -0.025; 95% CI: -0.037, -0.012; P<.001 and mean UX-point between-task difference, -0.021; 95% CI: -0.038, -0.005; P = .01). Inter-rectus distance and the distortion index did not change from rest or differ between tasks for controls (P≥.55). Fisheye CONCLUSION: Narrowing of the IRD during automatic curl-up in DRA distorts the LA. The distortion index requires further validation, but findings imply that less IRD narrowing with TrA preactivation might improve force transfer between sides of the abdomen. The clinical implication is that reduced IRD narrowing by TrA contraction, which has been discouraged, may positively impact abdominal mechanics.
  • Article
    Full-text available
    O objetivo do presente estudo foi determinar a prevalencia da DMRA em primiparas e multiparas no puerperio imediato. Trata-se de um e studo transversal com 261 puerperas. Para mensuracao da DMRA foram empregados tres pontos: 4,5 cm acima e abaixo da cicatriz umbilical e regiao umbilical. A graduacao foi feita pela tecnica das polpas digitais. Foi empregado os testes t para amostras independentes e Qui-Quadrado com p
  • Article
    Surgical technique plays an important role in preventing ventral midline incisional complications. The aim of this study was to compare the clinical and ultrasonographic outcome of three suture techniques for closure of the linea alba. In this prospective case series (n = 43), horses operated for acute abdominal intestinal disease through a midline incision were randomised in three groups: closure with a conventional continuous technique (Group 1), a small stitches continuous technique (Group 2) and the UX‐technique (shoe‐lace configuration, Group 3). Age, sex, body weight, type and duration of surgery were recorded and the suture to wound length ratio was calculated. Clinical evaluation of the wound (wound discharge) was performed daily during hospitalisation. At 7 weeks post‐operatively the linea alba was evaluated clinically and ultrasonographically. The linea alba width was measured halfway along the length of the incision. One horse in Group 1 had acute incisional dehiscence, but there were no further significant differences between the groups in the short term. Seven weeks post‐operatively two horses had complete herniation in Group 1 and one horse had partial herniation in Group 2. In the UX group no herniation occurred. The incidence of herniation was not significantly different between the groups. On ultrasound at 7 weeks the linea alba width was significantly smaller in Group 2 (P = 0.00029) and Group 3 (P = 0.0018) compared with Group 1, even with exclusion of the acute incisional dehiscence and two herniated horses. Limitations were the small group size and relatively low incidence of incisional complications for statistical analysis. It was concluded that the use of small stitches and the UX‐technique resulted in a smaller linea alba width compared with the conventional continuous suture technique and might therefore be preferred for closure of the linea alba in equine colic surgery.
  • Article
    Background: Weight loss after obesity and pregnancy is associated with excess abdominal skin and weakness of the abdominal wall, which is assumed to cause low back pain and reduce lung function. Today, abdominoplasty is the only known method to treat excess skin, and plication is used to improve aesthetics and function alone or in addition to surgery. There is lack of evidence concerning the surgery’s effect on trunk muscles, lung function, and physical function. The aim was to evaluate the effect on trunk muscle endurance, lung function and self-rated physical function after abdominoplasty with and without muscle plication. Aim: To evaluate the effect on trunk muscle endurance, lung function, and self-rated physical function after abdominoplasty with and without muscle plication. Methods: A series of 125 people were randomised to abdominoplasty with or without rectus abdominis muscle plication. Trunk muscle endurance, lung function, and self-rated physical function (disability rating index) were measured before and 1 year after surgery. Results: There were no significant differences in any of the measured variables between the groups either before or after surgery. A significant decrease (p = .02) in back muscle endurance was seen after abdominoplasty without muscle plication. A significant positive effect (p = .04) in one of the activities (running) assessed by DRI was reported after abdominoplasty with muscle plication. Conclusions: No significant differences in trunk muscle endurance, lung function, or self-rated physical function were found after abdominoplasty with vs without plication. As the primary indication for surgery was excess skin and not diastasis of the rectus abdominis muscles, there is a need for future trials before conclusions can be drawn of effect of abdominoplasty and plication.
  • Article
    Full-text available
    En este artículo vamos a exponer las actuales controversias más importantes que se están dando en el campo de la pared abdominal. La discusión actual acerca de el correcto uso del cierre del defecto o realizar técnica más anatómicas está siendo muy considerada ya que restaura la integridad de la línea media pero a su vez puede ocasionar otros problemas como son por ejemplo el aumento del dolor y el aumento del tiempo quirúrgico. La cirugía de la diástasis de rectos también es uno de los puntos clave en el avance de la cirugía laparoscópica en pacientes con alteraciones de la pared abdominal, principalmente en mujeres tras varios embarazos. Por último la fijación de las mallas sigue siendo controvertida ya que a pesar del amplio uso de tackers absorbibles y no absorbibles sigue siendo un problema las adherencias que se ocasionan a estos mismos. Cada vez más las líneas tienden hacia pegamentos y mallas autoadhesivas o a técnicas anatómicas donde se respete la integridad del peritoneo y no haya mallas en contacto con vísceras.
  • Article
    BACKGROUND Divarication of recti is characterised by thinning and widening of linea alba combined with laxity of the ventral abdominal musculature. It is often misclassified as a primary ventral hernia. But the musculofascial continuity of the midline and subsequent absence of a true hernia sets divarication apart from a ventral hernia. We wanted to evaluate the efficacy of surgical technique of rectus sheath repair and mesh placement in a series of 12 cases of divarication of recti. MATERIALS AND METHODS Patients underwent modified shoelace repair which involves reconstruction of linea alba along with use of polypropylene mesh to reinforce fascial layer. All the patients were followed up for a minimum of 24 months. A proforma was maintained for each patient, documenting patient details, complications and postoperative course. RESULTS All the 12 patients studied were females who had normal delivery at least 3 years prior to period of study. The age group of the patients varied between 26-36 years. About 33% of patients had pain beyond postoperative day 2, which needed parenteral analgesics for another 2 more days. None of the patients complained of pain on follow up in the OPD. CONCLUSION Modified Shoelace repair with mesh placement is a safe and effective procedure that can be used for surgical correction of divarication of recti.
  • Article
    Full-text available
    Introduction: Recently, the promising results of new procedures for the treatment of rectus diastasis with concomitant hernias using extraperitoneal mesh placement and anatomical restoration of the linea alba were published. To date, there is no recognized classification of rectus diastasis (RD) with concomitant hernias. This is urgently needed for comparative assessment of new surgical techniques. A working group of the German Hernia Society (DHG) and the International Endohernia Society (IEHS) set itself the task of devising such a classification. Materials and Methods: A systematic search of the available literature was performed up to October 2018 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library. A meeting of the working group was held in May 2018 in Hamburg. For the present analysis 30 publications were identified as relevant. Results: In addition to the usual patient- and technique-related influencing factors on the outcome of hernia surgery, a typical means of rectus diastasis classification and diagnosis should be devised. Here the length of the rectus diastasis should be classified in terms of the respective subxiphoidal, epigastric, umbilical, infraumbilical, and suprapubic sectors affected as well as by the width in centimeters, whereby W1 < 3 cm, W2 = 3− ≤ 5 cm, and W3 > 5 cm. Furthermore, gender, the concomitant hernias, previous abdominal surgery, number of pregnancies and multiple births, spontaneous birth or caesarian section, skin condition, diagnostic procedures and preoperative pain rate and localization of pain should be recorded. Conclusion: Such a unique classification is needed for assessment of the treatment results in patients with RD.
  • Book
    Full-text available
    The first laparoscopic cholecystectomy was performed by French surgeon Mouret in 1987, and this surgery is considered to be the beginning of a video-laparoscopic surgery. What is not to be confused here is that this is not the beginning of a laparoscopic surgery, but the beginning of a video-laparoscopic surgery. The first diagnostic laparoscopy was performed at the beginning of the twentieth century; the first surgical laparoscopy started in the third decade of the twentieth century. After 1950, laparoscopic surgery has entered into a faster development and spreading process, thanks to improvements in lens and light systems, and has been widely used not only for diagnostic purposes but also for therapeutic purposes. Laparoscopic surgery was more commonly used by gynecologists, and the first laparoscopic appendectomy was performed by Kurt Sem, a gynecologist, in 1982. Thanks to the discovery of microprocessors in the 1980s, the dimensions of the camera and light systems have become very small, and laparoscopic surgery has become more common in daily practice. Dr. Mouret's first laparoscopic cholecystectomy operation in 1987 was considered a sensational event and was the beginning of today's modern laparoscopic surgery. In this book, we intend to introduce some new surgical techniques to readers. I would like to thank all the authors who contributed to the preparation of this book.
  • Chapter
    Diastasis recti is a midline contour abnormality of the anterior abdominal wall that is characterized by the attenuation of the linea alba and usually is sequelae of pregnancy. Other causes include prior surgery and obesity. It is differentiated from a true hernia based on the absence of a fascial defect. Management options are diverse and well described and include a wide range from conditioning exercises to surgical repair with or without mesh. This chapter will review the characteristics and treatment modalities for diastasis recti.
  • Article
    Diastasis recti is a relatively common condition in which there is a midline abdominal bulge that can affect a variety of individuals. The etiology and diagnosis is well understood and optimal management depends on the degree of severity. Patients at high risk for diastasis recti include multiparous women, obese patients, and those with multiple previous operations. Diagnosis includes clinical examination and assessment of symptoms. Physical characteristics include a midline abdominal bulge without a fascial defect. Classification systems are based on the degree of separation between the paired midline rectus and myofascial deformity. Optimal management varies and includes simple plication of the midline defect, extensive plication of the anterior abdominal wall, and sometimes the use of resorbable or nonresorbable mesh.
  • Article
    Background: A separation of the abdominal muscles at the linea alba, known as diastasis recti abdominis (DRA), can occur after childbirth. However, the impact of DRA on abdominal muscle function is not clear. Objective: The objective was to determine if differences exist in trunk muscle function and self-reported pain and low back dysfunction between women with and without DRA at 12 to 14 months postpartum and if differences that emerge from the data are associated with the magnitude of the interrectus distance (IRD). Design: This study was a prospective observational case-control study. Methods: Women with (IRD ≥ 2.2 cm; n = 18) and without DRA (IRD < 2.2 cm; n = 22) participated. Maximal trunk flexion, extension, and rotation torque-generating capacity (Newton-meters), The Sit Up test (0-3 points), and the Sitting-Rising Test (0-10 points), and trunk flexion, extension, and lateral flexion endurance (seconds) were measured. Pain and disability were assessed using numerical pain rating scales (0-100) and the Roland Morris Low Back Pain Questionnaire (0-24 points). Women were compared using independent t tests and Mann-Whitney U-Tests. Pearson's product-moment and Spearman's rank correlation coefficients were used to determine associations; α = .05 was used for all tests. Results: Women with DRA demonstrated significantly lower trunk muscle rotation torque and scored lower on the sit-up test than those without DRA. IRD was negatively correlated with both trunk rotation torque (rho = -0.367) and sit-up test score (rho = -0.514). Limitations: The results of this study should not be generalized to women who present with moderate-to-severe IRDs or to multiparous women. Conclusion: The presence of DRA in primiparous women at 1 year postpartum is associated with trunk rotation strength and ability to perform a sit-up.
  • Article
    Postpartum rectus diastasis (RD) is commonly encountered in Western countries and often treated but it is a little-known clinical condition in Japan. We report two cases of postpartum RD. The first case was a 33-year-old woman with a history of two transvaginal deliveries, and the second case was a 36-year-old woman who had twins delivered by caesarean section. In both cases, significant RD was seen and laparoscopic plication was performed with nonabsorbable sutures and composite mesh reinforcement. The inter-recti distance (IRD) was measured preoperatively and 6 months postoperatively 3 cm above the umbilicus, at the umbilicus, and 2 cm below the umbilicus on computed tomography. In the first case, the IRD reduced from 26 mm, 42 mm, and 20 mm, respectively, to 10 mm, 15 mm, and 10 mm, respectively, 6 months after surgery. In the second case, IRD reduced from 26 mm, 32 mm, and 23 mm, respectively, to 16 mm, 9 mm, and 9 mm, respectively, 6 months after surgery. Both patients were satisfied with the cosmetic outcome. We report these cases with a review of the literature.
  • Article
    Full-text available
    Umbilical hernias are most common in women than men. Pregnancy may cause herniation or render a preexisting one apparent, because of progressively raised intra-abdominal pressure. The incidence of umbilical hernia among pregnancies is 0.08%. Surgical algorithm for a pregnant woman with a hernia is not thoroughly clear. There is no consensus about the timing of surgery for an umbilical hernia in a woman either who is already pregnant or planning a pregnancy. If the hernia is incarcerated or strangulated at the time of diagnosis, an emergency repair is inevitable. If the hernia is not complicated, but symptomatic an elective repair should be proposed. When the patient has a small and asymptomatic hernia it may be better to postpone the repair until she gives birth. If the hernia is repaired by suture alone, a high risk of recurrence exists during pregnancy. Umbilical hernia repair during pregnancy can be performed with minimal morbidity to the mother and baby. Second trimester is a proper timing for surgery. Asymptomatic hernias can be repaired, following childbirth or at the time of cesarean section (C-section). Elective repair after childbirth is possible as early as postpartum of eighth week. A 1-year interval can give the patient a very smooth convalescence, including hormonal stabilization and return to normal body weight. Moreover, surgery can be postponed for a longer time even after another pregnancy, if the patients would like to have more children. Diastasis recti are very frequent in pregnancy. It may persist in postpartum period. A high recurrence risk is expected in patients with rectus diastasis. This risk is especially high after suture repairs. Mesh repairs should be considered in this situation.
  • Chapter
    Diastasis recti abdominis (DRA) or increased inter-rectus distance (IRD) is characterized by the separation of the rectus abdominis muscles. It has its onset during pregnancy and the first weeks following childbirth. The reliability of the instruments used to assess this condition is unclear. There is scant knowledge on the prevalence and risk factors for development of the condition. There is little evidence on which exercises are most effective in reduction of DRA. The aims of our studies were to establish a reliable method for the assessment of the morphology of the abdominal wall, describe DRA prevalence, risk factors, and evaluate the acute response on the IRD induced by drawing-in and abdominal crunch exercises. The results of three methodological studies showed ultrasound imaging to be a reliable method for measuring IRD. The ultrasound transducer can be held relatively stationary in a clinical setting, to evaluate IRD. DRA is prevalent at 6 months postpartum, with a prevalence rate of 39%. The acute response on IRD produced by drawing-in exercise was a widening of the IRD in postpartum, while the abdominal crunch exercise induced an acute narrowing response of the IRD in pregnancy and in postpartum.
  • Article
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    Background Diastasis of the rectus abdominis muscles (DRAM) is characterised by thinning and widening of the linea alba, combined with laxity of the ventral abdominal musculature. This causes the midline to “bulge” when intra-abdominal pressure is increased. Plastic surgery treatment for DRAM has been thoroughly evaluated, though general surgical treatments and the efficacy of physiotherapy remain elusive. The aim of this systematic literature review is to evaluate both general surgical and physiotherapeutic treatment options for restoring DRAM in terms of postoperative complications, patient satisfaction, and recurrence rates. Method MEDLINE®, Embase, PubMed, PubMed Central®, The cochrane central registry of controlled trials (CENTRAL), Google Scholar, and the Physiotherapy Evidence Database (PEDro) were searched using the following terms: ‘rectus diastasis’, ‘diastasis recti’, ‘midline’, and ‘abdominal wall’. All clinical studies concerning general surgical or physiotherapeutic treatment of DRAM were eligible for inclusion. Result Twenty articles describing 1.691 patients (1.591 surgery/100 physiotherapy) were included. Surgical interventions were classified as plication techniques (313 patients; 254 open/59 laparoscopic), modified hernia repair techniques (68 patients, all open), and combined hernia & DRAM techniques (1.210 patients; 1.149 open/40 hybrid). The overall methodological quality was low. Plication techniques with interrupted sutures and mesh reinforcement were applied most frequently for DRAM repair. Open repairs were performed in 85% of patients. There was no difference in postoperative complications or recurrence rate after laparoscopic or open procedures, or between plication and modified hernia repair techniques. Physiotherapy programmes were unable to reduce IRD in a relaxed state. Though reduction of IRD during muscle contraction was described. Conclusion Both plication-based methods and hernia repair methods are used for DRAM repair. Based on the current literature, no clear distinction in recurrence rate, postoperative complications, or patient reported outcomes can be made. Complete resolution of DRAM, measured in a relaxed state, following a physiotherapy training programme is not described in current literature. Physiotherapy can achieve a limited reduction in IRD during muscle contraction, though the impact of this finding on patient satisfaction, cosmesis, or function outcome is unclear.
  • Chapter
    Diastasis recti is a condition characterized by attenuation of the linea alba and in severe cases, the linea semilunares. Multiparous women are at highest risk for developing diastasis recti because of the repetitive stretching of the anterior abdominal wall. Diagnosis is made by clinical examination demonstrating a midline abdominal bulge without a fascial defect. Classification systems have been proposed and based on the degree of rectus abdominis separation and myofascial deformity. Management options vary and depend on the degree of separation between the rectus abdominis as well as the oblique musculature. Simple plication is effective in cases of mild to moderate diastasis; however, more aggressive maneuvers utilizing resorbable or non-resorbable mesh products are often necessary for severe diastasis.
  • Objective: To compare inter rectus distance (IRD) of pregnant women with pelvic girdle pain (PGP) with those with other types of pregnancy-related back pain (BP). Study Design: Cross-sectional case-control design. Background: Abdominal and pelvic muscular stability is reduced in PGP. Compromise to these muscles occurs in diastasis rectus abdominis (DRA), resulting in a larger IRD. There is minimal conflicting research relating to DRA and PGP. Methods and Measures: The IRD of 66 pregnant women with self-reports of BP was first measured using nylon digital calipers with the abdominal muscles at rest and during a curl-up. All participants were evaluated using a pain location drawing, the numerical rating scale, the posterior pelvic pain provocation test, active straight leg raise, and the sacral compression test. Post hoc, a blinded research assistant classified subjects either into a PGP group if 3 of these tests were positive or into a nonspecific BP group. Results: In both groups, the IRD was widest at the umbilicus, narrowest below the umbilicus, and decreased with a curl-up. Odds ratios (ORs) were adjusted for factors when a relationship with PGP was suggested as follows: pregnancies 2 or more (OR = 1.07; 95% confidence interval [CI] = 0.40-2.87), weeks of gestation more than 25 (OR = 1.28; 95% CI = 0.49-3.35), and abdominal circumference more than 103 cm (OR = 1.75; 95% CI = 0.65-4.72). The adjusted ORs were very close to 1 with CIs that contain 1, indicating that PGP does not seem to be related to the IRD. Conclusions: There was no significant difference in the IRD of pregnant women with PGP compared with BP at any location or contraction condition.
  • Article
    Full-text available
    Purpose: Pregnancy-related diastasis rectus abdominis (DRA) is a prevalent condition. Consequences of a widened linea alba ultimately remain unknown. Current evidence on conservative management is conflicting, creating debate among practitioners. This study aims at developing a set of expert consensus-based recommendations for the assessment and conservative management of DRA. Methods: Selected Canadian women's health physiotherapists were invited to participate in a 3-phase Delphi consensus study. Phase I comprised 82 items divided into 6 domains, and to determine agreement, each item was rated on a 5-point Likert scale. Consensus was defined as agreement greater than 80%. In phase II, items receiving consensus were ranked and collapsed and summary descriptions were proposed. In phase III, final consensus was determined. Results: A total of 21 of the 28 (75%) invited experts participated. Phase I generated 38 consensus statements. Phase II translated into 30 consensus statements as well as modifications to proposed summary statements for each data category. Remaining items did not reach consensus. Consensus for 28 expert-based recommendations was achieved in phase III.
  • Article
    Full-text available
    Study design: Clinimetrics. Objectives: To investigate the intrarater between-session reliability of inter-rectus distance (IRD) measurement using ultrasound imaging in postpartum women with diastasis recti. Background: Diastasis recti, a separation of the rectus abdominis muscles at the linea alba, occurs as a result of pregnancy and is characterized by increased IRD. The measurement of IRD in this population is of interest to determine changes in diastasis recti severity over time, or in response to treatment. Ultrasound imaging has been proposed as a useful tool to measure IRD in women with diastasis recti; however, the consistency of IRD measurement in this population using ultrasound imaging has, to our knowledge, never been investigated. Methods: Ultrasound imaging was used to measure IRD in 20 women with diastasis recti on 2 different occasions. On each testing occasion, images were acquired at 4 locations along the linea alba while participants remained relaxed and while they performed a head lift to activate the rectus abdominis muscles. Reliability statistics included intraclass correlation coefficients, Bland-Altman analyses, minimum clinically important difference, and standard error of the measurement. Results: Between-session reliability of IRD measurement was high, particularly when measuring IRD at or above the umbilicus, as indicated by intraclass correlation coefficients greater than 0.90 and low standard error of the measurement and minimum clinically important difference values (below 0.17 cm and 0.46 cm, respectively). Reliability coefficients were poorer when measuring IRD below the umbilicus. Conclusion: When performed by an experienced investigator, ultrasound imaging is a reliable tool by which to measure IRD in postpartum women who have diastasis recti.
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    The plication of the anterior rectus sheath is a procedure that is performed by most surgeons during abdominoplasty. A main concern is whether the correction of recti diastasis is really effective and if it is stable. In order to verify the position of the rectus muscle, a CT-scan was used in 14 patients who underwent abdominoplasty with rectus plication to compare the preoperative situation of these muscles with their position 3 weeks and 6 months postoperatively. None of these patients had had previous abdominal surgery. The recti diastasis was corrected with a two-layer 2-0 Nylon suture. A dynamometer was used to measure the resistance force of the anterior aponeurosis of the rectus. In all cases the CT data shows that correction of the diastasis was achieved completely after 6 months.
  • Bermerkungen u ¨ber die Weisse Linie und u ¨ber den Bruch der Bauchwand, Dissertation, Jurjew (Dorpat): Schnaken-burg's Buchdruckerei
    • A Hagentorn
    Hagentorn A. 1902. Bermerkungen u ¨ber die Weisse Linie und u ¨ber den Bruch der Bauchwand, Dissertation, Jurjew (Dorpat): Schnaken-burg's Buchdruckerei.
  • Article
    : An objective classification for abdominoplasty based on myoaponeurotic deformities is described. Types A, B, C, and D correspond to different myoaponeurotic deformities. Patients with type A display rectus diastasis secondary to pregnancy, and plication of the anterior rectus sheath is indicated. Patients with type B present with laxity of the lateral and inferior areas of the abdominal wall after approximation of the anterior rectus sheaths. An L-shaped plication of the external oblique aponeurosis is performed in addition to the correction of rectus diastasis. Patients with type C are those whose rectus muscles are laterally inserted on the costal margins. Release and undermining of the rectus muscles from their posterior sheath and advancement of these muscles, attached to the anterior sheath, is the procedure of choice in these cases. Patients with type D display a poor waistline definition; external oblique muscle rotation associated with plication of the anterior rectus sheath is the procedure used to correct this deformity. Eighty-eight patients who underwent abdominoplasty were reviewed, and the incidence of each deformity was determined on this population. This study presents a practical classification that permits the plastic surgeon to critically evaluate which is the best option to correct abdominal deformities considering specific areas of myoaponeurotic weakness. (Plast. Reconstr. Surg. 108: 1787, 2001.) (C)2001American Society of Plastic Surgeons
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    Enduring diastasis repair is one of the yardsticks by which a successful abdominoplasty is measured, because the presence and size of diastasis recti are thought to be reliable indicators of abdominal wall laxity and protrusion. The author's study of the "normal" anatomy of diastasis challenges these concepts about diastasis recti. Ninety-two consecutive abdominoplasty patients, in whom intraoperative measurements of the linea alba were taken, were included in this study. The degree of abdominal wall protrusion was quantified by estimating the intra-abdominal fat volume in the upright patient as large, medium, or small. The most striking anatomical finding was that the linea alba has a limited range of stretch, most commonly between 1 and 2 inches, regardless of the extent of the abdominal girth. Moreover, eight patients with diastasis did not manifest abdominal protrusion, and in five patients, diastasis was absent, although a significant protrusion was present. Also, the site of the widest diastasis (supraumbilical/infraumbilical) frequently did not correspond to the site of the protrusion. Contrary to current thought, abdominal wall protrusions are caused by the stretching of the entire abdominal wall and not only the linea alba. Thus, significant abdominal wall protrusions may occur without diastasis and flat abdomens may exhibit a diastasis. Abdominal protrusion should replace diastasis as the prime indicator of abdominal wall laxity; stretching and the decision to perform diastasis repair should be influenced primarily by the evaluation of the protrusion rather than the diastasis.
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    This study was conducted to determine 1) the incidence of diastasis recti abdominis among women during the childbearing year and 2) the location of the condition along the linea alba. Clinicians have long noted its presence, prenatally and postnatally, but the magnitude of the problem is currently unknown. A cross-sectional design was used to test 71 primiparous women placed in one of five groups, based on placement within the childbearing year. A commonly accepted test for diastasis recti abdominis was performed. Palpation for diastasis recti abdominis at the linea alba was performed 4.5 cm above, 4.5 cm below, and at the umbilicus. Diastases were observed at all three places, but most often at the umbilicus. A significant relationship (p less than .05) was found between a woman's placement in her childbearing year and the presence or absence of the condition. Diastasis recti abdominis was observed initially in the women in the second trimester group. Its incidence peaked in the third trimester group; remained high in the women in the immediate postpartum group; and declined, but did not disappear, in the later postpartum group. These findings demonstrate the importance of testing for diastasis recti abdominis above, below, and at the umbilicus throughout and after the childbearing year.
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    An experiment was designed to compare the "holding power" or "staying power" of absorbable (polyglycolic acid and polyglactin 910) and nonabsorbable (nylon) suture. The aim of this experiment was to determine what provides the lasting strength of the bond between soft tissues that are approximated or plicated. When correcting the rectus diastasis during abdominoplasty, we used nylon sutures in 15 patients and absorbable synthetic sutures in 15 other patients. We then marked the closed folds of the rectus sheath with small metal vascular clips. Two days later and approximately 6 months after operation an upright anteroposterior abdominal x-ray was taken and the position of the metal clips was compared in the test groups. Although there was usually slight separation of the clips after 6 months, no significant difference between the two groups was noted, thereby indicating that holding power is not related to type of suture material but more likely to fibroplasia.
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    Abdominal myofascial plication has become an integral part of aesthetic abdominoplasty in an effort to narrow the waistline. Out of concern for the durability of this procedure, we performed a study using standard radiographs and clinical photographs to determine if there was long-term separation of the plication. Nine patients were entered into the study. In one patient immediate total separation of the plication occurred, and in another no separation occurred at all. The remaining patients' plication separated over only a 1-3-cm distance in the central part of the abdomen (original maximum width of plication was 12-16 cm). Aesthetic appearance was not compromised by this minor degree of separation. We conclude that the effects of musculoaponeurotic plication are durable.
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    Traditionally, the linea alba represents the principal route of approach in abdominal surgery and in consequence it is the commonest site of incisional hernia. The aim of this study was to review its morphology and to study its mechanical parameters of resistance, deformation and elasticity in order to compare these with the prosthetic materials most often used in the treatment of incisional hernia. Forty fresh cadavers were dissected and tests with a dynamometer and "bursting strength tester" were performed on samples taken from the linea alba at three levels: supra-umbilical, subumbilical and umbilical. Forty abdomino-pelvic scans were analysed. The morphologic results allowed definition of diastasis of the rectus mm. in terms of subject age: below 45 years of age diastasis was considered as a separation of the two rectus mm. exceeding 10 mm above the umbilicus, 27 mm at the umbilical ring and 9 mm below the umbilicus; above 45 years of age the corresponding values were 15 mm, 27 mm and 14 mm respectively. In the biomechanical study the subumbilical region exhibited a coefficient of elasticity greater than that of the supra-umbilical portion, but no significant difference in resistance was found between the different parts studied. The biomechanical results are compared with the corresponding data for prosthetic materials.
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    The results and complications of abdominoplasty in 20 consecutive multiparous women with very severe musculoaponeurotic laxity are presented. All patients presented with an abdomen that resembled a full-term pregnancy when the patient was in the erect posture. This very severe laxity was the end result of repeated pregnancies. All patients underwent a standard abdominoplasty with wide longitudinal plication using size 1 prolene sutures. Follow-up averaged 1 year. None of the patients had a major complication. However, all the patients had recurrence of the musculoaponeurotic laxity. Causes and classification of this recurrent laxity are discussed along with possible solutions.
  • Article
    The ideal suture for abdominal fascial closure has yet to be determined. Surgical practice continues to rely largely on tradition rather than high-quality level I evidence. The authors conducted a systematic review and meta-analysis of randomized controlled trials to determine which suture material and technique reduces the odds of incisional hernia. MEDLINE and Cochrane Library databases were searched for articles in English published from 1966 to 1998 using the keywords "suture", "abdomen/surgery", and "randomized controlled trials". Randomized controlled trials, trials of adult patients, and trials with a Jadad Quality Score of more than 3, comparing suture materials, technique, or both, were included. Two independent reviewers critically appraised study quality and extracted data. The reviewers were masked to the study site, authors, journal, and date to minimize bias. The primary outcome was postoperative incisional hernia. Secondary outcomes included wound dehiscence, infection, wound pain, and suture sinus formation. The occurrence of incisional hernia was significantly lower when nonabsorbable sutures were used. Suture technique favored nonabsorbable continuous closure. Suture sinuses and wound pain were significantly lower when absorbable sutures were used. There were no differences in the incidence of wound dehiscence or wound infection with respect to suture material or method of closure. Subgroup analyses of individual sutures showed no significant difference in incisional hernia rates between polydioxanone and polypropylene. Polyglactin showed an increased wound failure rate. Abdominal fascial closure with a continuous nonabsorbable suture had a significantly lower rate of incisional hernia. The ideal suture is nonabsorbable, and the ideal technique is continuous.
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    After the description of a general scheme of the architecture of collagen fibers in linea alba and rectus sheaths, variability and differences of fiber architectures were analyzed to describe their functional role. Using confocal laser scanning microscopy the diameter of each layer of fibril bundles was measured in linea alba and rectus sheaths of 12 human cadavers, and each fibril bundle was classified according to its orientation (oblique I and II, transverse). The mean diameter of fibril bundles in the supraumbilical region of the linea alba was smaller than in the infraumbilical region, and in the supraumbilical region the thickness of the linea alba was smaller than in the infraumbilical region. Analyzing sex-dependent differences in the fiber architecture of the linea alba, a larger amount of transverse fibers relative to oblique fibers were found in females in infraumbilical regions. The thickness of the infraumbilical linea alba was smaller in females than in males, while its width was larger. There exist gender differences in the architecture of the linea alba. However, whether these morphological differences demonstrate the adaptability of this fiber architecture to biomechanical stress in raised intraabdominal pressure in pregnancy remains to be proven. The transverse fibers act as a counterpart to the intraabdominal pressure whereas the oblique fibers are involved mainly in movements of the trunk.
  • Article
    Nylon and polydioxanone are two sutures commonly used to correct rectus diastasis. Polydioxanone, as an absorbable suture, has the advantage of not being palpable in thin patients. Because several forces act against the plication, an absorbable suture would not be efficient in these cases. In this study, two groups of 10 patients each were studied. These patients underwent abdominoplasty and correction of rectus diastasis. In the control group, 2-0 nylon was used to plicate the anterior aponeurosis and 0-polydioxanone was used in the experimental group. The tension of the abdominal wall was measured with a dynamometer in both groups. The width of rectus diastasis was measured 3 cm above and 2 cm below the umbilicus, using a computed tomography (CT) scan before the operation and 3 weeks and 6 months after surgery. The width of rectus diastasis was measured intraoperatively at the same levels. The data were analyzed by Student's t test. Both groups had similar abdominal wall tension on both levels. The diastasis recti was completely corrected at both levels, as confirmed by the 3-week postoperative CT scan and the 6-month CT scan. At the superior level, the width of the rectus diastasis on the preoperative CT scan (2.6 +/- 0.7 cm) was similar to the values obtained intraoperatively (2.7 +/- 0.6 cm), showing no significant statistical difference. At the inferior level, the largest difference between the preoperative CT scan and the intraoperative finding was 0.3 cm. In conclusion, the correction of rectus diastasis with 2-0 nylon and 0-polydioxanone was achieved and maintained after 6 months. CT scans are an accurate method for studying rectus diastasis and other muscles of the abdominal wall.
  • Article
    The purpose of this study was to assess the long-term durability of a standard vertical plication of the anterior rectus sheath. For this purpose, 70 women who had undergone this procedure as part of an abdominoplasty were sent a questionnaire, their records were studied, and they were invited back to the clinic for an examination using ultrasound. A total of 63 patients returned the questionnaire, and 40 were willing to attend a follow-up consultation and ultrasound investigation. The presence of rectus diastasis was assessed by ultrasound (a real time scanner with a 7.5-MHz linear probe). The study showed that after a follow-up of 32 to 109 months (mean, 64 months), standard plication of the abdominal wall with absorbable material led to residual or recurrent diastasis in 40 percent of the patients. It also confirmed that vertical plication only is not enough to improve the waistline and may eventually lead to epigastric bulging.
  • Article
    An objective classification for abdominoplasty based on myoaponeurotic deformities is described. Types A, B, C, and D correspond to different myoaponeurotic deformities. Patients with type A display rectus diastasis secondary to pregnancy, and plication of the anterior rectus sheath is indicated. Patients with type B present with laxity of the lateral and inferior areas of the abdominal wall after approximation of the anterior rectus sheaths. An L-shaped plication of the external oblique aponeurosis is performed in addition to the correction of rectus diastasis. Patients with type C are those whose rectus muscles are laterally inserted on the costal margins. Release and undermining of the rectus muscles from their posterior sheath and advancement of these muscles, attached to the anterior sheath, is the procedure of choice in these cases. Patients with type D display a poor waistline definition; external oblique muscle rotation associated with plication of the anterior rectus sheath is the procedure used to correct this deformity. Eighty-eight patients who underwent abdominoplasty were reviewed, and the incidence of each deformity was determined on this population. This study presents a practical classification that permits the plastic surgeon to critically evaluate which is the best option to correct abdominal deformities considering specific areas of myoaponeurotic weakness.
  • Article
    A retrospective chart review of 400 abdominal contour operations produced a series of 24 patients who underwent both their primary and then their secondary abdominal contour surgeries with the senior author (Matarasso). The majority of patients were classified and treated according to the abdominoplasty classification system previously described; however, a subgroup could not be categorized according to this system. In this study, the authors identified the secondary abdominal contour surgical experience of one surgeon. A comparison was made between two groups of patients treated for both primary and secondary operations: group I, considered early, less than 18 months after the previous operation; and group II, considered late, 18 or more months after the previous operation. There was a significant difference between groups I and II (chi2 = 4.12, p = 0.05); most patients had their surgical procedures before 18 months. For patients who underwent either a miniabdominoplasty or a full primary abdominoplasty, there was a statistically significant difference between the number of patients treated in group I and the number in group II (Fisher's exact test, D = 0, p = 0.05). Next, the nature of the secondary procedure was determined to be either a revisional procedure or a completely new reoperative procedure. The majority of patients underwent revision or "touch-ups," accomplished with either liposuction alone or in combination with scar revision. There was no significant difference between types of primary and secondary procedures performed in group I or group II. Secondary abdominal contour surgery accounted for 6 percent (24 of 400) of all abdominal contour procedures performed by one surgeon. Complete secondary surgery, performing an additional open procedure, occurred in 21 percent of cases (five of 24). Revision surgery (scar revision or removal of dog-ears) was performed in 29 percent of all cases (seven of 24). There was a 4 percent (one of 24) complication rate requiring operative intervention. This rate is consistent with that reported in the literature for primary abdominal contour surgery. With the overall acceptance of aesthetic surgery increasing, the number of patients undergoing abdominoplasty increasing, an aging population, and the safety of secondary abdominal contour surgery suggested from this review, it is likely that plastic surgeons will see more patients requesting secondary abdominal contour surgery in the future.
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    Full-text available
    Recently, a new model of fiber architecture of the linea alba has been described consisting of an oblique fiber layer of intermingling oblique fibers, a transverse fiber layer containing mainly transverse fibril bundles, and a variable, small irregular fiber layer. In this study the morphological model was proven using direction-specific biomechanical measurements of the linea alba. Thirty-one human abdominal walls were analyzed (16 male and 15 female). Six strips of collagen tissue with a width of 1 cm were exsected from each linea alba transversely, obliquely, and longitudinally according to the main fiber directions. An increasing force from 2 to 24 N was applied to these strips, and the corresponding strain represented by the relative elongation was measured, which allows the calculation of a direction-specific compliance of the tissue. The compliance is highest in longitudinal and smallest in transverse direction. In the infraumbilical part of the female linea alba the compliance was significantly smaller in the transverse direction than in the oblique direction. Moreover, the compliance in the transverse direction was significantly smaller in women than in men. A distinct anisotropy of morphological and biomechanical properties was demonstrated as well as sex-dependent differences. The compliance correlates with the distribution of fiber orientation in the linea alba. These biomechanical results constitute the functional correlation with the fiber morphology of the linea alba and correspond well to our earlier proposed model of fiber architecture.
  • Article
    Correction of rectus diastasis is a procedure performed by most surgeons during abdominoplasty. The purpose of this study was to demonstrate the long-term efficacy of the correction of rectus diastasis when plication of the anterior rectus sheath is performed with a nonabsorbable suture. Twelve female patients who underwent abdominoplasty were studied. Rectus diastasis was measured preoperatively with two computed tomographic scan slices: one above and one below the umbilicus. The bony levels where the slices were obtained served as a reference for the postoperative computed tomographic scans. During the operation, rectus diastasis was measured at the same levels as the preoperative scan slices. At the same time, the necessary force to bring the medial edge of the rectus muscle to the midline was measured with a dynamometer. Postoperative scans were obtained at 3 weeks and 6 months after the operation. A long-term follow-up scan was obtained from 76 to 84 months postoperatively for every patient. The 3-week postoperative scan proved that the correction of rectus diastasis had been achieved by the procedure. Despite the fact that there were different levels of abdominal wall resistance and that the average weight gain in this period was 6.5 kg, the long-term computed tomographic scans showed that there was no recurrence of rectus diastasis in any patient of this series, both in the superior and inferior abdomen. Plication of the anterior rectus sheath with nonabsorbable suture appears to be a long-lasting procedure for correcting rectus diastasis.
  • Article
    Full-text available
    Preoperative imaging evaluation may be useful for determining the position of recti abdominis muscles before their correction. The purpose of this study is to evaluate the accuracy of ultrasonography to measure the width of rectus abdominis muscle diastasis. Rectus diastasis was measured by ultrasonography preoperatively in 20 females. Rectus diastasis was measured in seven levels along the anterior rectus sheath by ultrasound after sustained deep inspiration and after expiration. Rectus diastasis, at the same levels, was also measured after its exposition during abdominoplasty by two independent observers, using a surgical compass. These values were compared using Wilcoxon's statistical text, for non independent values. There was no significant difference between the values obtained by ultrasound and those measured during surgery in the supra-umbilical levels and at the level of the umbilicus. However, below the umbilicus these values differed significantly, showing smaller values in the imaging evaluation. Ultrasonography is an accurate method to measure rectus diastasis above the umbilicus and at the umbilical level.