Rectus sheath plication in abdominoplasty: assessment of its longevity and a review of the literature.
BACKGROUND
Correction of rectus diastasis during abdominoplasty is controversial. Few published studies have investigated the long-term value of plication. This prospective study aims to assess the long-term durability of plication of the rectus sheath in abdominoplasty using ultrasound.


METHODS
A total of 28 consecutive abdominoplasty patients underwent rectus plication by the senior author (FSF) since 2006, using a 0/0 looped nylon suture. Rectus diastasis was measured preoperatively and postoperatively at 3, 6 and 12 month's intervals using a standardised ultrasound (7.5 MHz) probe, by the single senior radiologist (GJD). Diastasis of the recti was assessed at three fixed points: at the umbilicus, 6 cm above and 6 cm below the umbilicus. Diastasis was categorised using the Beer classification.


RESULTS
All patients were female with a mean age of 36 years and average of body mass index (BMI) 26 kg m(-2). The majority of subjects had previous abdominal surgery including caesarean sections (82%, n = 23) and had at least one previous pregnancy (87%), with only two patients (8.7%) in the study being nulliparous. Correction of diastasis was maintained in all patients despite previous pregnancies and abdominal surgery. Postoperative follow-up time averaged 28 months (range 12-43 months). According to the Beer classification, there was no recurrence of rectus diastasis at the 12-month postoperative ultrasound measurements. A significant reduction in the mean distance between rectus muscles before surgery and 12 months postoperatively was noted. Previous surgery did not have a statistically significant affect on preoperative rectus distance.


CONCLUSIONS
Vertical rectus plication with a non-absorbable suture demonstrates long-term durable results without any suture-related complications. Patient factors such as extent of preoperative rectus diastases and previous abdominal surgery did not appear to have a significant effect on the durability of the corrected diastasis.
Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK. stadiparthi@hotmail.com
S
S
Tadiparthi
K
K
Shokrollahi
G S
GS
Doyle
F S
FS
Fahmy
D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000000981:diagnostic imaging / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult