Background: Residual abdominal wall bulge, owing to rectus abdominis muscle diastasis, has been hindering the aesthetic outcome in
lipectomies over the past decades. The principal purpose of this case series was to explore the reliability of a new technique for midline
vertical plication that strengthens the anterior rectus sheath both vertically and transversely for the improvement of the results
regarding the aesthetic appearance and the long-term maintenance as well as long-term safety.
Methods: The study was conducted in Royal Hospital, Cairo, Egypt during the period from June 2014 to January 2017. The study
included female patients undergoing abdominoplasty for a bulging abdominal wall. All patients were evaluated by detailed history,
careful physical examination and photographed pre and postoperative.
Two separate prolene® 1 sutures were used in a zigzag fashion on either side of the midline to provide the desired effect, while hypnotic
Vicryl® 0 figure of eight sutures were taken to reinforce the vertical plication. After surgery, all cases were followed up for six months to
assess the outcomes of the procedure. The primary outcome measure was to assess the true and overt shortening as an objective
assessment of the success rate of the technique.
Results: The 30 patients, in which this technique was adopted, were assessed concerning overt and true shortening of the abdominal
wall. They had a mean age of 44.8±8.9 years and mean BMI of 33.7±2.6. The proposed technique warranted overt vertical shortening of
the distance from the xiphisternum to the symphysis pubis ranging from 11 to 36% with a mean of 25%. The true shortening owing to
rectus plication ranged from 19 to 33% with an average of 25 %. Twenty-five patients (83%) were highly satisfied with the overall result.
The most frequently encountered complication was superficial wound infection, while the most troublesome complication was midline
wound dehiscence (n=2).
Conclusion: Finally, we can conclude that our new technique for midline vertical plication that strengthens the anterior rectus sheath
both vertically and transversely has been demonstrated to be a reliable method to optimize the results of abdominoplasty. The technique
proved to be successful with appealing results and also stood the test of time.
