A study of postural changes after abdominal rectus plication abdominoplasty

Short-Term Changes in Posture and Pain of the Neck and Lower Back of Women Undergoing Lipoabdominoplasty: A Case Series Report

Objective

The purpose of this study was to analyze short-term variations in posture and intensity of neck and lower back pain in women undergoing lipoabdominoplasty.

Methods

This prospective case series study involved 17 women (age 43 ± 12 years, presurgical body mass index 27.0 ± 3.7 kg/m2). Participants were assessed preoperatively (T0) and at 15 (T15) and 30 days (T30) after surgery for clinical data (number of pregnancies, number of deliveries, presurgical body mass), neck and lower back angles calculated by photogrammetry, and pain intensity by numeric pain rating scale. Postoperative complications were assessed at T15 and T30.

Results

After adjusting for age and presurgical body mass index, there was an increase in forward head position in T15 and a return by T30 (marginal R2 = 0.411). The lower back showed an increase in flexion at T15 and return by T30 (marginal R2 = 0.266). No statistical evidence of significance was observed for changes in the intensity of neck (P > .355) or lower back (P > .293) pain. Complications were mild and common at T15; most of them resumed at T30.

Conclusion

A transient, nonlinear compensatory change in neck and lower back lordosis was observed 15 days after lipoabdominoplasty, with almost full recovery in the short term (30 days). No systematic change in pain intensity was observed within this period. Postsurgical complications were mild and common, and most of them resumed shortly after surgery.

Back Pain According to Roland-Morris Low Back Pain Scale After Abdominoplasty With Plication: A Prospective Case Series

INTRODUCTION

Chronic back pain is a physically debilitating condition that affects more than 80% of adults in the United States. A recent case series highlighted how abdominoplasty with plication can offer an alternative surgical approach for treating chronic back pain. These results have been corroborated by a large prospective series. However, this study excluded male and nulliparous subjects, who may also benefit from this surgery. Our group aims to investigate the effect of abdominoplasty on back pain in a more diverse patient population.

METHODS

Subjects older than 18 years undergoing abdominoplasty with plication were recruited. An initial survey called the Roland-Morris Disability Questionnaire (RMQ) was administered at the preoperative visit. This questionnaire inquiries about and grades the patient's history of back pain and surgery. Demographic, medical, and social history was also obtained. A follow-up survey and RMQ was then given 6 months after surgery.

RESULTS

Thirty subjects were enrolled. Subjects had a mean age of 43.4 ± 14.3 years. Twenty-eight subjects were female and 26 were postpartum. Twenty-one subjects reported initial back pain on the RMQ scale. Of these, 19 reported a decrease in RMQ score after surgery, including male and nulliparous subjects. A significant decrease in mean RMQ score was demonstrated 6 months after surgery (2.94-0.44, P < 0.001). Further subgroup analysis of female subjects demonstrated significantly decreased final RMQ score in parous women, vaginal or cesarean section delivery, and absence of twin gestation.

CONCLUSIONS

Abdominoplasty with plication significantly decreases self-reported back pain 6 months after surgery. These results support that abdominoplasty is not purely a cosmetic procedure but can also be applied therapeutically to improve functional symptoms of back pain.

Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence

PURPOSE

There are no universally agreed guidelines regarding which types of physical activity are safe and/or recommended in the perioperative period for patients undergoing ventral hernia repair or abdominal wall reconstruction (AWR). This study is intended to identify and summarise the literature on this topic.

METHODS

Database searches of PubMed, CINAHL, Allied & Complementary medicine database, PEDro and Web of Science were performed followed by a snowballing search using two papers identified by the database search and four hand-selected papers of the authors' choosing. Inclusion-cohort studies, randomized controlled trials, prospective or retrospective. Studies concerning complex incisional hernia repairs and AWRs including a "prehabilitation" and/or "rehabilitation" program targeting the abdominal wall muscles in which the interventions were of a physical exercise nature. RoB2 and Robins-I were used to assess risk of bias. Prospero CRD42021236745. No external funding. Data from the included studies were extracted using a table based on the Cochrane Consumers and Communication Review Group's data extraction template.

RESULTS

The database search yielded 5423 records. After screening two titles were selected for inclusion in our study. The snowballing search identified 49 records. After screening one title was selected for inclusion in our study. Three total papers were included-two randomised studies and one cohort study (combined 423 patients). All three studies subjected their patients to varying types of physical activity preoperatively, one study also prescribed these activities postoperatively. The outcomes differed between the studies therefore meta-analysis was impossible-two studies measured hernia recurrence, one measured peak torque. All three studies showed improved outcomes in their study groups compared to controls however significant methodological flaws and confounding factors existed in all three studies. No adverse events were reported.

CONCLUSIONS

The literature supporting the advice given to patients regarding recommended physical activity levels in the perioperative period for AWR patients is sparse. Further research is urgently required on this subject.

The Impact of Abdominoplasty vs Non-abdominoplasty on Weight Loss in Bariatric and Non-bariatric Malaysian Patients: A Multicentre Retrospective Study

Background and aims

Weight loss associated with abdominoplasty remains controversial as to whether it is contributed by the procedure alone, or if there are other patient factors. Therefore, we evaluated the relationship between weight loss in pre- and post-abdominoplasty and compared the weight loss of those who do not undergo abdominoplasty in bariatric and non-bariatric patients.

Methods

This study measured weight changes at designated time points in four different groups comprising 98 patients. The groups were abdominoplasty after bariatric surgery (group A), patients with abdominoplasty alone (B), bariatric surgery alone (group C), and diet alone (group D). Results are compared within and between the groups.

Results

Patients in groups A and B (patients who had abdominoplasty regardless with or without bariatric surgery) had a significant weight loss after six months (mean difference=10.70kg, 95% CI=4.05, 17.34, p<0.001) compared to pre abdominoplasty weight. Patients in group B were statistically significant (mean difference=4.01kg, 95% CI=0.92, 7.10, p=0.007) with 3.60kg weight reduction (4.59%). Patients in group A had clinically significant weight reduction (4.45kg, 5.14%) but it was not statistically significant (p>0.05) and had no significant additional weight reduction as compared to non-abdominoplasty (group C) patients (p=0.650). Patients in group C had a statistically significant difference from those in group D (F [1.00, 48.00] = 8.56, p=0.005) with an average weight loss of 3.60kg (4.59%) vs 2.56kg (2.8%) respectively.

Conclusions

All patients with abdominoplasty had significant weight loss after six months. Bariatric patients did not experience significant additional weight loss with abdominoplasty. Weight reduction after abdominoplasty alone was greater than diet alone. 

Impact of Rectus Diastasis Repair on Abdominal Strength and Function: A Systematic Review

Rectus diastasis plication performed during abdominoplasty aims to narrow the widened linea alba and return the rectus muscle bellies to their anatomic position. It is unclear whether plication improves abdominal strength and function.

This systematic review summarizes the effect of rectus plication on abdominal strength, function, and postoperative complications.

A comprehensive search of CINAHL, Embase, Medline and Web of Science was performed. Screening and data extraction were performed in duplicate. Data were extracted from the included articles, and outcomes were analyzed categorically.

A total of 497 patients from seven articles were included. Mean age was 44.5 years (range 20.5-72) and 94.4% were female. Three articles reported abdominal strength measurements, with two showing significant improvement. Four articles used the SF-36 survey, all demonstrating improvement in physical function subscale postoperatively. An additional six instruments were used to assess functional outcomes, of which four demonstrated significant improvement. The overall complication rate was 17.0%.

Rectus plication is commonly performed during abdominoplasty to improve abdominal form and function. While the literature to date is encouraging with respect to functional outcomes, improvements in abdominal strength are less consistent. Heterogeneity in patient population, outcome measures, and comparison groups limit the strength of our conclusions. Future research should include a large comparative study as well as a protocol for standardizing outcomes in this population.

Local high-frequency vibration therapy following eccentric exercises reduces muscle soreness perception and posture alterations in elite athletes

PURPOSE

Exercise-induced muscle damage produces painful sensations (delayed onset of muscle soreness, DOMS). DOMS causes compensatory postural adaptations, which in turn affect athletes' walking and running gait biomechanics. It is still debated whether the postural changes are due to impaired proprioception or pain perception. To disambiguate between these two contrasting hypotheses, we designed a study that tested post-exercise postural adjustments in two groups of athletes: a group who was administered a vibration therapy (VT), to attenuate pain perception, and a control group.

METHODS

Thirty professional futsal players were tested on five different occasions: baseline, eccentric exercises (EE) session day, 24, 48 and 72 h after EE. Vibration therapy (120 Hz) was applied on legs muscles for 15 min in the experimental group, while no vibration was applied in the control group. The measurements included: isokinetic evaluation, stabilometric test, perceived soreness evaluation and serum levels of creatine kinase, and lactate dehydrogenase.

RESULTS

48 h after EE, the control group showed changes in biomechanical parameters (antero-rotations of pelvis, p < 0.05). A substantial alteration in the hip kinematics was found, associated to a reduced contractile force (p < 0.01) and soreness perception. On the contrary, the VT group did not show any change in posture and pain perception. High-intensity VT decreases EE effects on muscle strength and DOMS.

CONCLUSIONS

DOMS significantly changes athletes' posture; but postural changes disappear following a VT therapy that decreases pain perception. It is concluded that soreness perception is the main cause of postural changes and that its effects can be counteracted using VT therapy.

Abdominoplasty Improves Low Back Pain and Urinary Incontinence

BACKGROUND

The authors studied the incidence of low back pain and urinary incontinence in the postpartum population presenting for abdominoplasty, and the extent of improvement following the operation.

METHODS

This multicenter prospective study used validated questionnaires: the Oswestry Disability Index for back pain and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form for urinary incontinence. Questionnaires were administered preoperatively and at 6 weeks and 6 months postoperatively.

RESULTS

Results cover 214 patients from nine centers. The mean age was 42.1 years, the mean parity was 2.5, and the mean body mass index was 26.3 kg/m. The mean surgical statistics were as follows: weight removed, 1222 g; liposuction volume, 795 ml; and diastasis, 4.5 cm. Eighty-seven percent of the abdominoplasties were either radical, high lateral tension, or high oblique tension. The mean Oswestry Disability Index score preoperatively was 21.6 percent, and 8.8 percent had no back pain. The mean score was 8 percent at 6 weeks and 3.2 percent at 6 months. These results are statistically significant. The mean International Consultation on Incontinence Questionnaire score preoperatively was 6.5; of the patients assessed, 27.5 percent had no incontinence. This score fell to 1.6 at 6 weeks, and the same, 1.6, at 6 months. These results are also statistically significant. Preoperative predictors of back pain were body mass index greater than 25 kg/m and umbilical hernia; predictors of incontinence were age older than 40 years and vaginal deliveries. There were no significant predictors of postoperative back pain or urinary incontinence improvement at 6 months. All methods of abdominoplasty produced similar improvement.

CONCLUSION

Abdominoplasty with rectus repair creates a significant improvement in the functional symptoms of low back pain and urinary incontinence.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Treatment of the scar after arthroscopic surgery on a knee

The aim of this paper is to present a treatment for scars based on percutaneous traction. This is a structural technique in which movements are performed against the barriers detected in different planes. The stages of this technique are described in detail along with the results after applying it to a postarthroscopic scar on a knee. The active and passive mobility of femoro-tibial and femoro-patellar articulations improved substantially after the treatment, as verified by signs such as pain relief, greater flexibility, disappearance of inflammation and a major recovery of tissue elasticity. A sonoelastography study of the portals and patellar tendon was carried out before and after therapy, showing semiquantitatively the recovery of the viscoelastic properties of the tissue.

Improvements in Vertebral-Column Angles and Psychological Metrics After Abdominoplasty With Rectus Plication

BACKGROUND

Substantial fluctuations in body weight can result in diastasis recti and weakening of the connections between the lateral abdominal muscles and the rectus sheath.

OBJECTIVES

The authors sought to determine the postural and psychological effects of abdominoplasty with vertical rectus plication.

METHODS

Forty women with substantial back and lumbar pain owing to abdominal lipodystrophy were evaluated in a prospective study. Preoperatively and 6 months postoperatively, patients underwent bidirectional radiography of the thoracic and lumbar regions. A visual analog scale (VAS), the Beck Depression Inventory (BDI), and the Nottingham Health Profile (NHP) were applied to assess physical, psychological, and quality-of-life changes following surgery.

RESULTS

Significant improvements in posture, assessed in terms of lumbar lordosis, thoracic kyphosis, and the lumbosacral angle, were observed 6 months after abdominoplasty with rectus plication. Results of the VAS and BDI indicated significant improvements in pain and quality of life, respectively. Results of the NHP indicated significant postoperative improvements in fatigue, pain, and sleep.

CONCLUSIONS

Abdominoplasty with rectus plication improves posture by tightening the thoracolumbar fascia. In selected patients, abdominoplasty can reduce back and lumbar pain, thereby improving quality of life.

Does Abdominoplasty Add Morbidity to Incisional Hernia Repair? A Randomized Controlled Trial

Background Abdominoplasty is considered an operation linked to a considerable rate of morbidity. The convenience of simultaneously performing an incisional hernia repair and an abdominoplasty remains controversial. Methods A total of 111 patients were randomized prospectively to compare isolated incisional hernia repair and hernia repair when combined with abdominoplasty. Primary end points were in-hospital stay and early morbidity. Secondary end points were late morbidity, recurrences, and quality of life. Patients were followed-up for 24 months. Results Duration of the surgical procedure differed significantly between both groups (39 vs 85 minutes, P < .001) and postoperative hospital stay (2.5 vs 3.5 days; P < .001). No statistically significant differences in early or late morbidity between both groups were detected. The perceived quality of life for patients was higher in the combined surgery group (P < .001) that in the isolated hernia repair group. Conclusions Postoperative in-hospital stay and early and late morbidity do not differ significantly between isolated incisional hernia repair and simultaneous hernia repair with abdominoplasty, but associated abdominoplasty provides a higher quality of life when indicated.

A review of the utilization of baropodometry in postural assessment

Postural deviations have been linked to a series of different kinds of pain and dysfunction. Since the human foot is the basis of support and propulsion for gait, and baropodometric analysis assesses dysfunctions of the feet, it may be valuable in terms of postural assessment. Therefore, the aim of this literature review was to investigate which studies have used this baropodometric equipment and how the equipment was used, as well as to discuss the scientific problems and solutions associated with the study and clinical practice of baropodometry. Twenty-eight of the 48 articles found in the Pubmed and Lilacs databases were used. The baropodometer has the potential to provide excellent research in the postural field and related areas. However, baropodometry requires standardization and an improved calibration system. Further significant scientific papers, using properly calibrated equipment, are important in order to improve the quality of the technique and display evidence of its clinical and scientific value.