title: Analysis of the strength of the abdominal fascia in different sutures used in abdominoplasties.
abstract: BACKGROUND
  Protrusion of the abdominal wall secondary to abdominoplasty may occur in patients with weakness of the aponeurotic structures. The anterior layer of the rectus abdominis muscle consists of fibers that are transverse rather than vertical. Based on this anatomical feature, vertical sutures are suggested for the correction of diastasis recti, since they include a greater amount of fascial fibers and thus would be more resistant to tensile strength than horizontal ones.
  
  
  METHODS
  The anterior layers of the rectus abdominis muscles of 15 fresh cadavers were dissected. Two vertical lines were marked on each side of the linea alba, corresponding to the site where plication is usually performed in abdominoplasties. Three abdominal levels were evaluated: the supraumbilical, umbilical, and infraumbilical levels. A simple suture was placed in the vertical direction in one group and in the horizontal direction in the other group, at each of the three levels previously described. These sutures were connected to a dynamometer, which was pulled medially toward the linea alba until rupture of the aponeurosis occurred.
  
  
  RESULTS
  The mean strength required to rupture the aponeurotic structures in which the vertical sutures had been placed was greater than for the horizontal ones (p < 0.0001).
  
  
  CONCLUSIONS
  The vertical suture of the rectus abdominis sheaths was stronger than the horizontal suture because of the more transversal arrangement of its aponeurotic fibers. Thus, routine use of the vertical suture in plications of the aponeurosis of the rectus abdominis muscles is suggested.
authors.affiliation: Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Luis Henrique
authors.initials: LH
authors.lastname: Ishida
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
authors.forename: Marco Vinicius Losso
authors.initials: MV
authors.lastname: Longo
authors.forename: Helio Ricardo Nogueira
authors.initials: HR
authors.lastname: Alves
authors.forename: Pedro Henrique Quintino
authors.initials: PH
authors.lastname: da Silva
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Ishida
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: D034861:Abdominal Wall / Q000503:physiopathology / Q000601:surgery*; D002102:Cadaver; D005205:Fascia; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures; D013718:Tensile Strength