Doubling of the Rectus Abdominis Fascia

| In patients who have lost a lot of weight after being severely overweight,

§ there is sometimes overstretching of the abdominal muscles so that

2 these move away from one another in the center. In extreme cases, a midline hernia occurs. Appropriate surgical treatment should then be carried out for these.

■ In order to achieve a good result for the tightening of the abdominal wall, doubling of the fascia longitudinally is routinely carried out with 0 Vicryl sutures (interrupted mattress sutures) and, depending on the findings, doubling obliquely. This doubling of the fascia must be based on the individual findings. This allows a good base to be created for the later skin/fat tightening.

■ For body contouring, suction can also be carried out in the area of the hips during the operation via the open abdominal wall. There are many variations in aesthetic/plastic surgery for optimizing the result. However, a basic requirement is good basic knowledge and mastery of standard operations.

Fascia Surgery Define Navel

Xiphoid process

Median line Costal arch

Position of the navel a: Lower edge of the incision b: Previous position of the navel

Xiphoid process

Median line Costal arch

Position of the navel a: Lower edge of the incision b: Previous position of the navel

Defining the Resection Boundaries with Upper Body Flexed at 30°

■ Following prior precise wound revision and hemostasis, the entire cutaneous/fatty flap is pulled down under traction with the upper body flexed (30°) to define the boundaries for later resection. In an ideal case, point b will meet point a. This ensures that a vertical excision will not be necessary and therefore no troubling scar will occur. If the abdominal wall is very slack, the distance may be greater. In such cases, it is important that the later scar is formed section by section, without tension and that it is not retracted and there is no surplus skin with a distended overhang.

Vertical Scar

Fixation suture

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