Rectus Abdominis-Myofascial release Technique Versus External Oblique-Plication Technique for Safe Waist Enhancement in Abdominoplasty

Abstract

Patients seek abdominoplasty to restore amore youthful appearance to their abdomen asa whole. The modern abdominoplasty mustaddress not only skin and subcutaneous tissuebut also the muscular abdominal wall to maximizeaesthetic outcome of the procedure. Themusculoaponeurotic plicationtechniques used in this studyimproved the abdominal wall contour. Patients underwent these procedures have been pleased with their results.

We present a series of 30 female patients with laxity of the abdominalwall musculature. They underwent abdominoplasty with plication of the musculoaponeurotic layer of the abdominal wall. 15 cases received the rectus abdominis myofascial release technique and 15 cases received the external oblique plication technique.

The rectus abdominis myofascial release technique and the external oblique plication technique, both have a beneficial role on the improvement of the waist/hip ratio and both result in increase of the intraabdominal pressure postoperatively.

The 2 techniques were evaluated and compared. There is statistical significant difference between both techniques as regard the waist enhancement, the increase in intraabdominal pressure and the post-operative pain.The rectus abdominis myofascial release technique has a less increase in the intraabdominal pressure postoperatively, and a better waist enhancement than the external oblique plication technique. The intensity of the postoperative pain is higher in the external oblique plication than the rectus abdominis myofascial release technique with statistically significant difference. However, there is no statistical significant difference in terms of the duration of the postoperative pain.

The increase in the intraabdominal pressurehad no effect on thepost-operative complications and there is no statistically significant difference between both techniques as regard complications rate. So we concluded that the rectus abdominis myofascial release technique has a better effect on the waist enhancement, considered safer on the intra-abdominal pressure and causing less intense postoperative pain than the external oblique plication technique. However, the Rectus abdominis myofascial release technique as described by Ramirez is more invasive operation compared to other plication techniques due to the incision of the anterior rectus sheath that puts the patient under risk of incisional hernia if no care was taken in the postoperative period to avoid strain. Accordingly, the rectus abdominis myofascial release technique should be reserved for patients with wide rectus diastasis that will benefit from the higher waist enhancement achieved by this technique, while patients with no or minimal diastasis can achieve a pleasing result with the external oblique plication technique. The limitations of this study are the limited period of follow up and the relatively small number of casesincluded.On the basis of this study, it is recommended that a further investigations to be done on a wider scale of cases.