Introduction
Methods
Patient evaluation and decision-making
Suture plication | Well-fixed narrow mesh |
---|---|
Mild rectus diastasis | Severe rectus diastasis |
2–3 cm of rectus diastasis | 5 cm or greater rectus diastasis |
Localized abdominal wall stretching at linea alba | Generalized abdominal wall stretching between semilunar lines |
Rectus muscles each about 6 cm wide | Rectus muscles wider than 7–8 cm wide |
Good tone | Floppy abdomen |
Female | Male |
No scars | Already has a vertical scar |
No weight loss | Massive weight loss, or with elevated BMI (men) |
Low demand physical activity | High demand |
Fear of mesh | Acceptance of mesh |
Initial procedure | Revision abdominoplasty |
Surgical technique
Skin abdominoplasty
Standard incision in the majority of females
Vertical incision in some females and all males
Low transverse incision | Vertical incision |
---|---|
Women | Men |
Hypogastric skin excess | Epigastric skin excess |
No scars | Pre-existing vertical scar |
No umbilical hernia | Umbilical hernia |
Moderate rectus diastasis | Severe rectus diastasis |
More skin elevation | Less skin elevation |
Less risk adverse | More risk adverse |
Short torso | Long torso |
Prefers to walk straighter after surgery | |
Always wears a shirt | |
Massive weight loss | |
Revision abdominoplasty | |
Need to remove prior umbilical hernia mesh |
Rectus diastasis repair with a narrow well-fixed mesh
Results
Demographic characteristics | ||
---|---|---|
Sex | Male | Female |
Total no. of mesh abdominoplasty patients | 16 | 40 |
Age (mean, range) | 57 (35–74) | 42 (29–70) |
Clinical characteristics | Mesh abdominoplasty (n = 16) | Mesh abdominoplasty (n = 40) |
---|---|---|
BMI (kg/m2) (mean, range, standard deviation) | 29 (24–37) (4.0) | 26 (18–40) (5.3) |
Smoking status | ||
Current (n, %) | 2 (12%) | 0 (0%) |
Former (n, %) | 1 (6%) | 0 (1%) |
Never (n, %) | 13 (81%) | 40 (95%) |
Diabetes | ||
Yes (n, %) | 3 (19%) | 0 (4%) |
No (n, %) | 13 (81%) | 40 (96%) |
Concomitant hernia (patients) (n) | ||
Epigastric | 9 | 9 |
Umbilical | 7 | 13 |
Width of rectus diastasis (cm) (mean, range) | 6 (2–8) | 7 (4–15) |
Follow-up visits in first 6 months (mean, range) | 2 (1–6) | 3 (1–7) |
Hospital stay (days) (mean, range) | 2.5 (0–5) | 2.5 (0–6) |
SSI (n, %) | 2 (12%) | 1 (3%) |
SSO (n, %) | 0 (0%) | 0 (0%) |
Other complication | Drain site erythemia, infected mesh strip knot at umbilicus 6 months after procedure | Superficial suture abscess, resolved with dermal knot removal and antibiotics |
Hospital readmission (n, %) | 0 (0%) | 0 (0%) |
Muscle revision (n, %) | 0 (0%) | 1 (3%) |
Office soft tissue revision (n, %) | 1 (6%) | 9 (23%) |
Follow-up | 73 weeks | 45 weeks |