Faustino Leandro Dario, Ferreira Lydia Masako, Ramirez Oscar M, Nahas Fábio Xerfan
Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Division of Plastic Surgery, Cleveland Clinic, Fort Lauderdale, FL, United States.
J Plast Reconstr Aesthet Surg. 2021 Dec;74(12):3361-3370. doi: 10.1016/j.bjps.2021.05.015. Epub 2021 Jun 5.
The components separation technique (CS) is used for the reconstruction of complex abdominal wall defects. Release and undermining of the rectus abdominis muscle (RAM) and external oblique muscle (EOM) decrease tension on the abdominal midline, reducing recurrence of ventral hernia, but causes major changes in the physiology of abdominal wall. The purpose of the study was to determine which muscle release and undermining produces the lowest tension on the midline.
Twenty fresh cadavers were dissected and the anterior and posterior layers of the rectus sheath were isolated in the midline. The forces necessary to advance the layers of the rectus sheath to the mid abdomen were measured bilaterally at two points located 3 cm above and 2 cm below the umbilicus, and at 3 different stages: before any muscle release; after release and undermining of the right RAM and left EOM; and after release and undermining of the left RAM and right EOM. Comparisons of tensile forces were conducted separately for the different muscles involved, layers of the rectus sheath, measurement points, and stages of separation.
Tension on the abdominal midline after the release and undermining of both the RAM and EOM was reduced by 56% (p <0.05), 42% after the release and undermining of the EOM alone (p <0.05), and 35% after release and undermining of the RAM alone (p <0.05).
Release and undermining of the EOM by CS led to lower tension on the abdominal midline compared to that associated with the release of the RAM alone.
组织分离技术（CS）用于复杂腹壁缺损的重建。腹直肌（RAM）和腹外斜肌（EOM）的松解和游离可降低腹中线的张力，减少腹疝复发，但会引起腹壁生理的重大改变。本研究的目的是确定哪种肌肉松解和游离能使中线张力降至最低。
解剖20具新鲜尸体，在中线分离腹直肌鞘的前后层。在脐上3 cm和脐下2 cm的两个点双侧测量将腹直肌鞘各层推进至中腹部所需的力，并在3个不同阶段进行测量：未进行任何肌肉松解前；右侧RAM和左侧EOM松解和游离后；左侧RAM和右侧EOM松解和游离后。对不同参与肌肉、腹直肌鞘各层、测量点和分离阶段分别进行拉力比较。
RAM和EOM均松解和游离后，腹中线张力降低了56%（p<0.05）；仅EOM松解和游离后降低了42%（p<0.05）；仅RAM松解和游离后降低了35%（p<0.05）。
与仅松解RAM相比，CS技术对EOM进行松解和游离可使腹中线张力更低。
