Veríssimo Pamella, Nahas Fábio Xerfan, Barbosa Marcus Vinicius Jardini, de Carvalho Gomes Heitor Francisco, Ferreira Lydia Masako
Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 715, 4o. andar, São Paulo, CEP 04024-002, Brazil.
Aesthetic Plast Surg. 2014 Apr;38(2):379-86. doi: 10.1007/s00266-014-0272-z. Epub 2014 Jan 30.
Abdominal wall deformity secondary to pregnancy is multidirectional. Plication of the anterior rectus sheath is the most widely used technique for correction of this condition. However, it would be desirable to simultaneously perform the transverse and longitudinal repair of this deformity. The aim of this study was to assess changes in the length of the musculoaponeurotic layer after diastasis recti repair using triangular mattress sutures.
Thirty-one women with Nahas' type III/A deformity were divided into two groups: the triangular mattress suture (TS) group and the continuous suture (CS) group. All patients underwent conventional abdominoplasty and diastasis recti repair with medial longitudinal plication performed between two metal clips. The two types of suture were used in both groups. In the TS group, after a CS was performed and removed, TSs were used and maintained in place. In the CS group, the order of suture placement was reversed. The distance between clips was measured before and immediately after suturing and at 3 weeks and 6 months postoperatively using plain abdominal radiographs. Statistical analysis was conducted using Friedman's analysis of variance and Wilcoxon's test.
The use of TSs significantly reduced the length of the aponeurosis compared with both the intraoperative situation without suture (P<0.001) and the use of CS (intraoperatively and 6 months after surgery; P<0.001).
The repair of diastasis recti using TSs resulted in vertical shortening of musculoaponeurotic layer immediately after the procedure and in the long term.
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妊娠继发的腹壁畸形是多方向的。腹直肌前鞘折叠术是矫正这种情况最广泛使用的技术。然而，同时进行这种畸形的横向和纵向修复会更好。本研究的目的是评估使用三角形褥式缝合修复腹直肌分离后肌筋膜层长度的变化。
31例患有纳哈斯III/A型畸形的女性被分为两组：三角形褥式缝合（TS）组和连续缝合（CS）组。所有患者均接受传统腹壁成形术及腹直肌分离修复术，在两个金属夹之间进行内侧纵向折叠。两组均使用两种缝合方式。在TS组中，先进行连续缝合并拆除，然后使用三角形褥式缝合并固定在位。在CS组中，缝合顺序相反。使用腹部平片在缝合前、缝合后即刻以及术后3周和6个月测量夹子之间的距离。采用弗里德曼方差分析和威尔科克森检验进行统计分析。
与术中未缝合情况（P<0.001）以及使用连续缝合（术中及术后6个月；P<0.001）相比，使用三角形褥式缝合显著缩短了腱膜长度。
使用三角形褥式缝合修复腹直肌分离在术后即刻和长期均导致肌筋膜层垂直缩短。
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