Diastasis Recti: Clinical Anatomy
Advanced Aesthetic Associates; Phoenix, Ariz. (Repta)
The Hunstad Center; Charlotte, N.C. (Hunstad)
Correspondence to Dr. Repta; Advanced Aesthetic Associates; 9225 N 3rd Street, Suite 103; Phoenix, Ariz. 85020; firstname.lastname@example.org
We read with interest the article by Dr. Brauman regarding diastasis recti and the sources of abdominal wall protrusions. We would like to commend the author on addressing a subject that is frequently under-evaluated with respect to abdominal contouring. Abdominal protrusion can be a result of multiple factors including extraabdominal fat, intraabdominal fat, diastasis recti, abdominal wall hernia, as well as global myofascial laxity.
Traditional abdominoplasty techniques address extraabdominal fat through liposuction and resection, and correction of diastasis recti and abdominal wall hernia(s) through direct fascial repair including plication of the linea alba. Intraabdominal fat can be a significant source of abdominal protrusion, but it is not addressed in traditional abdominoplasty techniques.
The last potential source of abdominal wall protrusion is global myofascial laxity.
Abdominoplasty patients with significant abdominal protrusion and relatively little intra- and extraabdominal fat frequently have abdominal wall laxity that is much greater than the degree of diastasis recti present. Deferring plication or plicating only sufficiently to decrease the width of the linea alba frequently results in inadequate correction of abdominal wall laxity and the persistence of abdominal wall protrusion.
Based on these observations, we prefer to use the term myofascial plication to better describe the process of global myofascial laxity correction.1 The technique is similar to standard diastasis recti plication; however, plication involves imbricating a wider portion of the anterior rectus sheath as determined by preoperative assessment and intraoperative estimation with the patient under muscular relaxation. The process of myofascial plication shorthens the width of the anterior rectus sheath and in turn pulls the paired linea semilunaris toward midline, resulting in reapproximation of the medial edges of the rectus muscles.1 This entire process results in overall tightening of the abdominal wall as a myofascial unit. The frequency and significance of global myofascial laxity are often under-appreciated in the process of abdominal wall tightening for the abdominoplasty patient.
Remus Repta, M.D.
Advanced Aesthetic Associates
Joseph P. Hunstad, M.D.
The Hunstad Center
1. Hunstad JP, Repta R. The Atlas of Abdominoplasty
. London: Saunders;2008.
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