Nahas Fabio Xerfan, Kimura Alexandro Kenji, Barbosa Marcus Vinícius Jardini, Juliano Yara, Ferreira Lydia Masako
Division of Plastic Surgery, Federal University of São Paulo/EPM, São Paulo, Brazil.
Ann Plast Surg. 2011 Sep;67(3):303-8. doi: 10.1097/SAP.0b013e3181fb4a92.
The purpose of this study is to evaluate the influence of the undermining of the subcutaneous tissue on the tension of the abdominal wall, after the components separation of the abdominal muscles. Twenty adult cadavers were studied. The resistance of the medial advancement of both anterior and posterior recti sheaths was represented by the traction index and measured in 2 levels-3 cm above and 2 cm below the umbilicus. Traction indices were compared in the following 3 consecutive dissection situations: (1) after the subcutaneous tissue undermining laterally to the semilunaris line; (2) after the dissection of the rectus muscle from its posterior sheath associated with the release of the external oblique muscle; (3) after the subcutaneous tissue undermining laterally to the anterior axillary line. Friedman and Spearman tests were used to compare the results. There was no statistical significant difference between the subcutaneous tissue undermining laterally to the semilunaris line and that laterally to the anterior axillary line, when associated with the musculoaponeurotic dissections. In conclusion, limited subcutaneous undermining does not influence the tension of closure of the musculoaponeurotic layer after the components separation technique in cadavers.
本研究的目的是评估在腹直肌各层分离后，皮下组织潜行分离对腹壁张力的影响。对20具成年尸体进行了研究。通过牵引指数来表示腹直肌前后鞘向内侧推进的阻力，并在脐上3 cm和脐下2 cm两个水平进行测量。在以下3种连续的解剖情况下比较牵引指数：（1）在皮下组织向半月线外侧潜行分离后；（2）在将腹直肌与其后鞘分离并松解腹外斜肌后；（3）在皮下组织向前腋线外侧潜行分离后。采用Friedman检验和Spearman检验对结果进行比较。当与肌筋膜解剖相关时，皮下组织向半月线外侧潜行分离和向前腋线外侧潜行分离之间无统计学显著差异。总之，在尸体中采用各层分离技术后，有限的皮下潜行分离不会影响肌筋膜层闭合的张力。
