54. Percutaneous correction of diastasis of the abdominal rectus muscles by means of the Elasticum thread and two-tipped needle
KEYWORDS: diastasis of the abdominal rectus muscles, elastic thread, Jano needle
Diastasis of the abdominal rectus muscles is caused by increased pressure and volume in the abdominal cavity as a result of pregnancy, sport, excessive and repetitive physical effort, or obesity.
The Elasticum EP4 elastic thread mounted on the two-tipped Jano needle can be used to correct moderate diastases of the rectus muscles, without leaving scars. This Elastic Plastic Surgery procedure enables the muscles to be drawn back together in a stable manner, without tissue dissection and without leaving scars. Patient selection is important.
Palpation and echography are used to identify the diastasis of the abdominal rectus muscles accurately. It is useful to draw the pathway of the thread.
Local anesthesia is achieved by means of a modified Klein solutionUsing a n°15 blade, the operator makes a skin incision inside the umbilical scar. A Klemmer is then used to create a cavity in the direction of the margin of the rectus muscle. The two-tipped needle is inserted into the umbilical incision and penetrates the muscle fascia. The Jano needle is extracted until its posterior tip emerges from the muscle fascia and is situated in the subcutaneous tissue. At this point, the operator moves the needle laterally by about 2 cm. The posterior tip of the needle now becomes anterior and again passes through the fascia of the rectus muscle, penetrates the subcutaneous tissues and passes through the fascia of the contralateral rectus muscle. The two-tipped needle is extracted from the fascia; it is then moved laterally, again pinches the fascia and follows the previously drawn line. At each step, the elastic thread is pulled through and placed under tension. A “safety tool” is used to keep the peritoneum away from the pathway of the thread. Having reached the end of the diastasis, the two-tipped needle returns along the previous pathway in order to strengthen the suture. The elastic thread emerges from the small incision inside the umbilicus. The ends of the thread are placed under tension and knotted. The small skin incision is then sutured. For about two months, the patient will wear a containment corset.
Palmieri B., Capurro S. (2021). Percutaneous correction of diastasis of the abdominal rectus muscles by means of the Elasticum thread and two-tipped needle. CRPUB Medical Video Journal. Elastic Plastic Surgery section. www.crpub.org.
Does the two-tipped needle fix the elastic thread blindly?
Yes. This is nothing new. In the face, for example, the elastic thread is often anchored transcutaneously to the fascia of Loré. The Jano needle can be curved slightly in order to facilitate its passage. The pathway of the needle can be checked intraoperatively by means of echography.
Who are the ideal candidates for this procedure?
Slim subjects who have a diastasis of about 3 cm - 4 cm.
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