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      Presentación de una nueva clasificación de plicaturas en abdominoplastia Translated title: Presentation of a new classification in abdominoplasty plications

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          Abstract

          Resumen Introducción y objetivo. El concepto de abdominoplastia se ha redefinido en los últimos años siendo el manejo del componente musculoaponeurótico un elemento fundamental para mejorar el contorno de la pared abdominal. Sin embargo, las indicaciones de plicatura no están claramente establecidas, encontrando descritas innumerables técnicas por diversos autores. El presente trabajo tiene por objetivo revisar la evidencia referente a las técnicas quirúrgicas de plicatura abdominal y proponer una clasificación de las mismas. Material y método. Búsqueda en la literatura de las técnicas quirúrgicas de plicatura en abdominoplastia y presentación de una clasificación original para las mismas. Resultados. Proponemos una clasificación de plicaturas basada en 3 elementos topográficos. El primero, la región anatómica predominante donde se realiza la plicatura (Tipo I o de línea alba, Tipo II o de rectos y Tipo III o de oblicuos). El segundo, la relación con el nivel del ombligo (supraumbilical, infraumbilical o supra-infraumbilical). Y el tercero, la orientación en el espacio de la plicatura (vertical, transversa u oblicua). Conclusiones. Consideramos que nuestra clasificación aporta una nomenclatura objetiva para la descripción de las plicaturas en abdominoplastia, ayudando así a definir sus indicaciones y a mejorar la comunicación de resultados.

          Translated abstract

          Abstract Background and objective. The concept of abdominoplasty has been redefined in recent years, being the management of the musculoaponeurotic component a key element to improve abdominal wall contour. However, indications for plication are not clearly established, and countless techniques have been described by various authors. The objective of this work is to review the evidence regarding the surgical techniques of plication and propose a new classification for them. Methods. A search was carried out in the literature about surgical techniques of plication in abdominoplasty, and from this, an original classification for abdominoplasty plications is presented. Results. Our classification is based on 3 topographic elements. First, the main anatomical region where the plication is performed (Type I or linea alba, Type II or rectus abdominis and Type III or oblique muscles). Second, the relationship with umbilicus level (above, below or above-and-below). And third, the orientation in the space (vertical, transverse or oblique). Conclusions. Our classification provides an objective nomenclature for the description of plications in abdominoplasty, thus helping to define its indications and improve the communication of results.

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          Most cited references28

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          The normal width of the linea alba in nulliparous women.

          The function of the linea alba is to maintain the abdominal muscles at a certain proximity to each other. In the case of long-lasting increased intra-abdominal pressure, the linea alba widens. Yet, as the existence of the linea a priori implicates a physiological distance between the two rectus muscles, the question arises as to what the normal width of the linea alba is. To evaluate the normal width of the linea alba, we examined 150 nulliparous women between 20 and 45 years of age with a body mass index < 30 kg m(-2) by ultrasound at three reference points: the origin at the xiphoid and 3 cm above and 2 cm below the umbilicus. The examination revealed a broad range of widths at the three reference points. The linea was widest at 3 cm above the umbilicus (-35 mm), followed by the reference point 2 cm below the umbilicus (-31 mm) and the origin at the xiphoid (-31 mm). The mean width was 7 +/- 5 mm at the xiphoid and 13 +/- 7 mm above and 8 +/- 6 mm below the umbilicus. For the definition of the normal width of the linea, the 10th and 90th percentiles were taken. The linea alba can be considered "normal" up to a width of 15 mm at the xiphoid, up to 22 mm at the reference point 3 cm above the umbilicus and up to 16 mm at the reference point 2 cm below the umbilicus in nulliparous women.
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            Abdominal Lipectomy: An Approach to It through an Analysis of 300 Consecutive Cases

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              An aesthetic classification of the abdomen based on the myoaponeurotic layer.

              F X Nahas (2001)
              An objective classification for abdominoplasty based on myoaponeurotic deformities is described. Types A, B, C, and D correspond to different myoaponeurotic deformities. Patients with type A display rectus diastasis secondary to pregnancy, and plication of the anterior rectus sheath is indicated. Patients with type B present with laxity of the lateral and inferior areas of the abdominal wall after approximation of the anterior rectus sheaths. An L-shaped plication of the external oblique aponeurosis is performed in addition to the correction of rectus diastasis. Patients with type C are those whose rectus muscles are laterally inserted on the costal margins. Release and undermining of the rectus muscles from their posterior sheath and advancement of these muscles, attached to the anterior sheath, is the procedure of choice in these cases. Patients with type D display a poor waistline definition; external oblique muscle rotation associated with plication of the anterior rectus sheath is the procedure used to correct this deformity. Eighty-eight patients who underwent abdominoplasty were reviewed, and the incidence of each deformity was determined on this population. This study presents a practical classification that permits the plastic surgeon to critically evaluate which is the best option to correct abdominal deformities considering specific areas of myoaponeurotic weakness.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                June 2023
                : 49
                : 2
                : 117-128
                Affiliations
                [1] Santiago Santiago de Chile orgnameUniversidad Finis Terrae Chile
                [2] Santiago orgnameUniversidad Finis Terrae y Clínica Made Chile
                [3] Clínica Made Santiago orgnameCirujano General Chile
                [4] Barcelona Cataluña orgnameUniversitat Internacional de Catalunya Spain
                Article
                S0376-78922023000200004 S0376-7892(23)04900200004
                10.4321/s0376-78922023000200004
                9fae85f2-70e5-446d-8496-1807855e33c4

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 23 March 2023
                : 22 May 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 12
                Product

                SciELO Spain

                Categories
                Estética

                Abdominoplastia,Plicatura,Diástasis de rectos,Recto abdominal,Músculos abdominales oblicuos,Abdominoplasty,Plication,Diastasis recti,Rectus abdomini,Abdominal oblique muscles

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