Top

Aesthetic Plastic Surgery

Published in:

Open Access 18-01-2022 | Abdominoplasty | Original Article

A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study

Authors: Evangelos Keramidas, Stavroula Rodopoulou, Maria-Ioanna Gavala

Published in: Aesthetic Plastic Surgery | Issue 5/2022

Abstract

Background

This study presents a classification system and treatment method to correct Rectus diastasis (RD) during abdominoplasty.

Materials and methods

One hundred and sixty seven patients undergoing abdominoplasty were enrolled between April 2014 and January 2018. Forty-three patients did not present with RD and were excluded from the analysis. Mean age was 40.32 years, mean BMI was 23.84, and minimum follow-up was 24 months. A four-type (A: mild 2–3cm, B: moderate 3–5cm, C: severe 5–7cm, and D: very severe 7–9cm) classification system is described. A different treatment method is performed in each category using continuous and interrupted absorbable sutures. Postoperatively patients filled up a questionnaire that involved the level of pain, the postoperative day they performed specific indoor/outdoor activities, and the evaluation of the aesthetic result.

Results

No statistically significant differences were observed between the four RD types regarding pain, complications, and return to specific activities. All types of RD had the same low rate complication profile. The seroma rate was 0.81%. The infection rate was 0.81%, and the thromboembolism and the pneumonic embolism rate was 0%. After 2–6 years of follow-up no clinical recurrence of rectus diastasis was observed. All reoperations (14.52%) were performed due to scar deformities. Mean pain score levels were very low (<1.5) and within a week most patients returned to specific indoor and outdoor activities. Most patients were extremely satisfied with the results.

Conclusions

In this article, we present an updated classification system and treatment protocol to provide surgeons a safe and standardized method that produces high-quality aesthetic results.

Level of evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Available only for authorised users

Akram J, Matzen SH (2014) Rectus abdominis diastasis. J Plast Surg Hand Surg 48(3):163–169. https://doi.org/10.3109/2000656X.2013.859145CrossRefPubMed

Ranney B (1990) Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med 43(10):5–8PubMed

Reinpold W, Köckerling F, Bittner R et al (2019) Classification of Rectus Diastasis-A Proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS). Front Surg. 6:1. https://doi.org/10.3389/fsurg.2019.00001CrossRefPubMedPubMedCentral

ElHawary H, Abdelhamid K, Meng F, Janis JE (2020) A Comprehensive, Evidence-Based Literature Review of the Surgical Treatment of Rectus Diastasis. Plast Reconstr Surg 146(5):1151–1164. https://doi.org/10.1097/PRS.0000000000007252CrossRefPubMed

Mommers EHH, Ponten JEH, Al Omar AK, de Vries Reilingh TS, Bouvy ND, Nienhuijs SW (2017) The general surgeon’s perspective of rectus diastasis A systematic review of treatment options. Surg Endosc 31(12):4934–4949CrossRef

Thoma A, Hassan Y, Santos J (2019) Are We Measuring What Really Counts? Aesthetic Surg J 39(7):777–785. https://doi.org/10.1093/asj/sjz083CrossRef

Rath AM, Attali P, Dumas JL, Goldlust D, Zhang J, Chevrel JP (1996) The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surg Radiol Anat 18(4):281–288. https://doi.org/10.1007/BF01627606CrossRefPubMed

Nahas FX (2001) An aesthetic classification of the abdomen based on the myoaponeurotic layer. Plast Reconstr Surg 108(6):1787. https://doi.org/10.1097/00006534-200111000-00057CrossRefPubMed

Beer GM, Schuster A, Seifert B, Manestar M, Mihic-Probst D, Weber SA (2009) The normal width of the linea alba in nulliparous women. Clin Anat 22(6):706–711. https://doi.org/10.1002/ca.20836CrossRefPubMed

10.

Benjamin DR, Frawley HC, Shields N, Georgiou C, Taylor NF (2020) Establishing measurement properties in the assessment of inter-recti distance of the abdominal muscles in a postnatal women. Musculoskelet Sci Pract. 49:102202. https://doi.org/10.1016/j.msksp.2020.102202CrossRefPubMed

11.

van de Water ATM, Benjamin DR (2016) Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther 21:41–53. https://doi.org/10.1016/j.math.2015.09.013CrossRef

12.

Janes LE, Fracol ME, Dumanian GA (2019) Appreciation of Postpartum Changes of the Rectus Muscles in Primary and Repeated Abdominoplasty. Plast Reconstr Surg 144(2):197–204CrossRef

13.

Elkhatib H, Buddhavarapu SR, Henna H, Kassem W (2011) Abdominal musculoaponeuretic system: magnetic resonance imaging evaluation before and after vertical plication of rectus muscle diastasis in conjunction with lipoabdominoplasty. Plast Reconstr Surg 128(6):733e–740e. https://doi.org/10.1097/PRS.0b013e318230c8a1CrossRefPubMed

14.

de Mendes D, A, Nahas FX, Veiga DF, et al (2007) Ultrasonography for measuring rectus abdominis muscles diastasis. Acta Cir Bras 22(3):182–186CrossRef

15.

Pannucci CJ, Barta RJ, Portschy PR et al (2012) Assessment of postoperative venous thromboembolism risk in plastic surgery patients using the 2005 and 2010 Caprini Risk score. Plast Reconstr Surg 130(2):343–353. https://doi.org/10.1097/PRS.0b013e3182589e49CrossRefPubMedPubMedCentral

16.

Keramidas E, Rodopoulou S (2018) Co-Author: Abstract: The Greek Line Technique Perfecting Aesthetic Results in Abdominoplasty. Plast Reconstr Surg Glob Open. https://doi.org/10.1097/01.GOX.0000546960.87257.98CrossRefPubMedCentral

17.

Nahas FX, Ferreira LM, de Mendes J, A, (2004) An efficient way to correct recurrent rectus diastasis. Aesthetic Plast Surg 28(4):189–196CrossRef

18.

Bucaria V, Boccuzzi A (2021) Autologous Dermal Mesh in Severe Postpregnancy Recti Muscles Diastasis. Aesthetic Plast Surg 45(1):198–211. https://doi.org/10.1007/s00266-020-01991-wCrossRefPubMed

19.

Nahas FX, Faustino LD, Ferreira LM (2019) Abdominal Wall Plication and Correction of Deformities of the Myoaponeurotic Layer: Focusing on Materials and Techniques Used for Synthesis. Aesthetic Surg J 39:78–84CrossRef

20.

Bellido Luque J, Bellido Luque A, Valdivia J et al (2015) Totally endoscopic surgery on diastasis recti associated with midline hernias The advantages of a minimally invasive approach Prospective cohort study. Hernia 19(3):493–501CrossRef

21.

Brauman D (2008) Diastasis recti: clinical anatomy. Plast Reconstr Surg 122(5):1564–1569. https://doi.org/10.1097/PRS.0b013e3181882493CrossRefPubMed

22.

Gama LJM, Barbosa MVJ, Czapkowski A, Ajzen S, Ferreira LM, Nahas FX (2017) Single-Layer Plication for Repair of Diastasis Recti: The Most Rapid and Efficient Technique. Aesthetic Surg J 37(6):698–705. https://doi.org/10.1093/asj/sjw263CrossRef

23.

Rodrigues MA, Nahas FX, Reis RP, Ferreira LM (2015) Does Diastasis Width Influence the Variation of the Intra-Abdominal Pressure After Correction of Rectus Diastasis? Aesthetic Surg J 35(5):583–588. https://doi.org/10.1093/asj/sju091CrossRef

24.

Nahas FX, Ferreira LM, Augusto SM, Ghelfond C (2005) Long-term follow-up of correction of rectus diastasis. Plast Reconstr Surg 115(6):1733–1736CrossRef

25.

Nahas FX, Ferreira LM, Ely PB, Ghelfond C (2011) Rectus diastasis corrected with absorbable suture: a long-term evaluation. Aesthetic Plast Surg 35(1):43–48. https://doi.org/10.1007/s00266-010-9554-2CrossRefPubMed

26.

Nahas FX, Augusto SM, Ghelfond C (1997) Should diastasis recti be corrected? Aesthetic Plast Surg 21(4):285–289. https://doi.org/10.1007/s002669900127CrossRefPubMed

27.

Nahas FX, Augusto SM, Ghelfond C (2001) Nylon versus polydioxanone in the correction of rectus diastasis. Plast Reconstr Surg 107(3):700–706CrossRef

28.

Frame J (2017) Commentary on: Single-Layer Plication for Repair of Diastasis Recti: The Most Rapid and Efficient Technique. Aesthetic Surg J 37(6):706–707. https://doi.org/10.1093/asj/sjw279CrossRef

29.

de Castro EJP, Radwanski HN, Pitanguy I, Nahas F (2013) Long-term ultrasonographic evaluation of midline aponeurotic plication during abdominoplasty. Plast Reconstr Surg 132(2):333–338. https://doi.org/10.1097/PRS.0b013e3182958ad2CrossRefPubMed

30.

al-Qattan MM, (1997) Abdominoplasty in multiparous women with severe musculoaponeurotic laxity. Br J Plast Surg 50(6):450–455CrossRef

31.

van Uchelen JH, Kon M, Werker PM (2001) The long-term durability of plication of the anterior rectus sheath assessed by ultrasonography. Plast Reconstr Surg 107(6):1578–1584CrossRef

32.

Mestak O, Kullac R, Mestak J, Nosek A, Krajcova A, Sukop A (2012) Evaluation of the long-term stability of sheath plication using absorbable sutures in 51 patients with diastasis of the recti muscles: an ultrasonographic study. Plast Reconstr Surg 130(5):714e–719e. https://doi.org/10.1097/PRS.0b013e318267d806CrossRefPubMed

33.

Rosen A, Hartman T (2011) Repair of the midline fascial defect in abdominoplasty with long-acting barbed and smooth absorbable sutures. Aesthetic Surg J 31(6):668–673. https://doi.org/10.1177/1090820X11415242CrossRef

34.

Nahabedian MY (2018) Management Strategies for Diastasis Recti. Semin Plast Surg 32(3):147–154. https://doi.org/10.1055/s-0038-1661380CrossRefPubMedPubMedCentral

35.

Caldeira AML, Carrión K, Jaulis J (2018) Repair of the Severe Muscle Aponeurotic Abdominal Laxity with Alloplastic Mesh in Aesthetic Abdominoplasty. Aesthetic Plast Surg 42(4):1039–1049. https://doi.org/10.1007/s00266-018-1101-6CrossRefPubMed

36.

Boudreault DJ, Sieber DA (2019) Getting the Best Results in Abdominoplasty: Current Advanced Concepts. Plast Reconstr Surg 143(3):628e–636e. https://doi.org/10.1097/PRS.0000000000005378CrossRefPubMed

37.

No Title. https://www.smokefreeworld.org/state-of-smoking/greece/.

38.

Pluvy I, Garrido I, Pauchot J et al (2015) Smoking and plastic surgery, part I Pathophysiological aspects: update and proposed recommendations. Ann Chir Plast Esthet 60(1):3–13. https://doi.org/10.1016/j.anplas.2014.06.011CrossRef

39.

Rodrigues MA, Nahas FX, Gomes HC, Ferreira LM (2013) Ventilatory function and intra-abdominal pressure in patients who underwent abdominoplasty with plication of the external oblique aponeurosis. Aesthetic Plast Surg 37(5):993–999. https://doi.org/10.1007/s00266-013-0158-5CrossRefPubMed

40.

Huang GJ, Bajaj AK, Gupta S, Petersen F, Miles DAG (2007) Increased intraabdominal pressure in abdominoplasty: delineation of risk factors. Plast Reconstr Surg 119(4):1319–1325. https://doi.org/10.1097/01.prs.0000254529.51696.43CrossRefPubMed

41.

Pereira N, Sciaraffia C, Danilla S, Parada F, Asfora C, Moral C (2016) Effects of Abdominoplasty on Intra-Abdominal Pressure and Pulmonary Function. Aesthetic Surg J 36(6):697–702. https://doi.org/10.1093/asj/sjv273CrossRef

42.

Bajaj AK (2016) Commentary on: Effects of Abdominoplasty on Intra-Abdominal Pressure and Pulmonary Function. Aesthetic Surg J 36(6):703–704. https://doi.org/10.1093/asj/sjw030CrossRef

43.

Keramidas EG, Rodopoulou SG (2007) Ropivacaine versus lidocaine in digital nerve blocks: a prospective study. Plast Reconstr Surg 119(7):2148–2152. https://doi.org/10.1097/01.prs.0000260725.33655.88CrossRefPubMed

44.

Fiala T (2015) Tranversus abdominis plane block during abdominoplasty to improve postoperative patient comfort. Aesthetic Surg J 35(1):72–80. https://doi.org/10.1093/asj/sju019CrossRef

45.

Sforza M, Andjelkov K, Zaccheddu R, Nagi H, Colic M (2011) Transversus abdominis plane block anesthesia in abdominoplasties. Plast Reconstr Surg 128(2):529–535. https://doi.org/10.1097/PRS.0b013e31821e6f51CrossRefPubMed

46.

Klassen AF, Cano SJ, Scott A, Tsangaris E, Pusic AL (2014) Assessing outcomes in body contouring. Clin Plast Surg 41(4):645–654. https://doi.org/10.1016/j.cps.2014.06.004CrossRefPubMed

Title: A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study
Authors: Evangelos Keramidas
Stavroula Rodopoulou
Maria-Ioanna Gavala
Publication date: 18-01-2022
Publisher: Springer US
Keywords: Abdominoplasty
Abdominoplasty
Liposuction
Liposuction
Abdominoplasty
Body Contouring
Liposuction
Published in: Aesthetic Plastic Surgery / Issue 5/2022
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI: https://doi.org/10.1007/s00266-021-02739-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence IV

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence IV

Please log in to get access to this content

Other articles of this Issue 5/2022

Effect of Co-transplanting Stromal Vascular Fraction-Gelatin and Platelet-Rich Fibrin on the Long-Term Maintenance of Fat Volume

Piezo-Assisted Dorsal Preservation in Rhinoplasty: When and Why

Review of Early Signs of Breast Implant Infection

Myo-Glandular Flap Breast Reduction: Preventing the Bottoming-Out Deformity—A Novel Technique

Comparison of Postoperative Scarring in Asian Women After Supra-brow and Sub-brow Blepharoplasty: A Retrospective Study

Efficacy of Early Application of 1540 nm Non-ablative Fractional Laser and Silicones to Improve Post-epicanthoplasty Scars