16 May 2014
The gradual increase in girth in pregnancy and in weight gain, causes tissue-expansion and stretching.
When the above situation is reversed,ie. after delivery of a baby or weight loss, there are different types of reversal in the various tissues affected.
Muscles do best and can almost recover completely. The two large columns of muscles in the anterior abdominal wall, the right and left Rectus Abdominus muscles, which given great strength to the anterior abdominal wall as well as the back , are such examples.
The fascia covering these muscles, a strong sleeve around the muscles and fused ( attached ) in the midline, stretch up to a point before further stretch causes irreversible damage.
When the muscle recovers, the fascia does not and this results in a week and stretched midline.
Instead a diffuse midline keeping the muscles together, the central stretched ellipse of fascia causes the muscles to be separated, weakening the anterior abdominal wall as well as the back.
This” divarication or diastasis” of the muscles is equivalent to a midline hernia and causes significant weakening of the anterior abdominal wall, and protrusion of the abdominal contents, especially in the standing position.
The radical abdominoplasty procedure described by Dr. Ivor Pitanguy, the doyen of Brazilian plastic-surgery, is an excellent operation which fixes this problem very well.
The surgery results in the re-establishment of the central fascial fusion, with the muscles back together in the midline and with recovery of strength and contour.
A bonus of this operation is the removal of a good amount of skin and fat from the anterior abdominal wall.
The surgery is major, needing general anaesthesia and hospitalisation as well as time for recovery, but the excellent resolution of the problem makes it all worthwhile.
Recurrent abdominal wall hernias.
An extension of this technique is the use in the correction of recurrent abdominal wall hernias, resulting from multiple previous operations and attempted hernia repairs.
A very significant factor in this type of repair is the avoidance of the use of synthetic mesh grafts with its many attendant problems.
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