RESUMEN
PURPOSE: To assess collagen content and types in the rectus abdominis muscle of cadavers of different ages. METHODS: Forty fresh adult male cadavers within 24 h of death were obtained from an Institute of Legal Medicine and divided by age at death into Group 1 (mean age, 23.3 years; range, 18-30 years; n = 20) and Group 2 (mean age, 46.2 years; range, 31-60 years; n = 20). From each cadaver, samples of the rectus abdominis muscle measuring 1 cm(2) were collected 3 cm superiorly and 2 cm inferiorly to the umbilicus. Histological sections were prepared and stained with picrosirius red and Masson's trichrome stain for visualization of total collagen fibers, and immunohistochemical analysis was performed to distinguish types I, II, III, IV and V collagen. RESULTS: No significant differences in total collagen were found between groups by Masson's trichrome staining. However, picrosirius red staining revealed a significantly greater amount and higher concentration of total collagen and types I and III collagen in Group 1 than in Group 2 (P < 0.05). All but type II collagen were detected by immunohistochemistry in both groups. No significant difference in type IV collagen was found between groups. Type V collagen was detected by immunohistochemistry in both groups, but quantification was not possible due to background staining. CONCLUSION: The amounts of types I and III collagen in the rectus abdominis muscle were significantly smaller in older subjects.
Asunto(s)
Colágeno/análisis , Recto del Abdomen/química , Adolescente , Adulto , Factores de Edad , Cadáver , Colágeno Tipo I/análisis , Colágeno Tipo III/análisis , Muerte , Humanos , Masculino , Persona de Mediana Edad , Recto del Abdomen/patología , Adulto JovenRESUMEN
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.
Asunto(s)
Músculos Abdominales/patología , Músculos Abdominales/cirugía , Adolescente , Adulto , Fascia/patología , Femenino , Humanos , Lipectomía , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodosRESUMEN
An objective classification for abdominoplasty based on subcutaneous and skin deformities is described. Type 0 patients are those who present excess fat with very little excess skin or without surplus skin, on which liposuction is indicated. Types I, II, and III are patients that demonstrate various degrees of excess skin and three basic patterns of skin resection are described. Type I patients present mild excess skin with a high umbilicus. Type II patients are those with mild excess skin and a well-positioned umbilicus, as well as patients with moderate excess skin. Type III patients present severely excessive skin. One hundred and eleven patients with abdominal deformity 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 skin and subcutaneous deformities.
Asunto(s)
Abdomen/cirugía , Procedimientos de Cirugía Plástica/métodos , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
Waist definition is an important goal of abdominoplasty. The purpose of this report is to study the effect of advancement and rotation of the external oblique muscles in the waistline. Twenty cadavers were dissected. Two parameters were analyzed: measurement of the waist circumference and the width of overlapped skin flaps of the abdomen in the midline. Three stages of dissection were compared: (1) initial stage, in which the myoaponeurotic structure of the anterior abdominal wall was intact; (2) stage 1, after advancement of the rectus muscles and its anterior aponeurosis toward the midline; and (3) stage 2, after advancement and rotation of the external oblique muscle. A significant statistical difference was found when waist circumference measured before dissection was compared with values obtained after the procedure. When the width of the overlapped skin flaps was compared during the different stages of dissection, a significant statistical difference was observed after each stage (paired t test). Therefore, the approximation of the rectus muscles alone improves the waistline, and when associated with external oblique muscle flap advancement and rotation, the cosmetic result in this area is even better. In conclusion, the procedure described decreases waist circumference and improves the frontal view of the waist.
Asunto(s)
Músculos Abdominales/anatomía & histología , Músculos Abdominales/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Cadáver , Femenino , Humanos , MasculinoRESUMEN
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.
Asunto(s)
Músculos Abdominales/cirugía , Nylons , Polidioxanona , Suturas , Músculos Abdominales/diagnóstico por imagen , Adulto , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias , Cirugía Plástica/métodos , Suturas/efectos adversos , Tomografía Computarizada por Rayos XRESUMEN
The clinical features and the plastic surgery management of a 23-year-old woman with cutis laxa are presented. Two rhytidectomies were performed in this patient within 1 year. The first was associated with a SMAS flap; the second employed a prehairline incision. The evolution of the aging facial appearance 10 years after the last face lift was evaluated and compared with the preoperative situation. Repeated face lifts seem to be an interesting way to manage patients with cutis laxa. Unlike patients with other disorders of the connective tissue, those with cutis laxa have no vascular fragility and heal well. The role of plastic surgery and the clinical features and timing for operation are reviewed and discussed.
Asunto(s)
Cutis Laxo/congénito , Cutis Laxo/cirugía , Cara/cirugía , Ritidoplastia/métodos , Adulto , Cutis Laxo/patología , Cara/anomalías , Femenino , Humanos , Reoperación , Resultado del TratamientoRESUMEN
The tension required to pull the anterior and the posterior rectus sheaths toward the midline was studied in 20 fresh cadavers at two levels: 3 cm above and 2 cm below the umbilicus. The quotient of the force used to mobilize the aponeurotic site to the midline and its resulting displacement was called the traction index. These indices were compared in three situations: (1) prior to any aponeurotic undermining, (2) after the incision of the anterior rectus sheath and the undermining of the rectus muscle from its posterior sheath, and (3) after additionally releasing and undermining the external oblique muscle. A significant decrease in aponeurotic resistance was observed after each dissection. The anterior sheath showed higher resistance to traction compared with the posterior sheath on both levels. No statistical difference was noted in the comparison of the values of the aponeurosis above and below the umbilicus. These results suggest that these procedures are effective in assisting in the closure of abdominal wall defects because these maneuvers decrease substantially the tension required for advancement of the aponeurotic edges.