الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 110 |  |  |
| | | from | 110 | | |
Abstract
The abdomen is the region of the trunk below the diaphragm and actually it constitutes its main part. Consequentially, its shape and size can alter under different conditions, such as varying degrees of distention of the contained hollow organ and the phases of respiration.
The abdominal wall is formed of skin, two layers of superficial fascia, three layers of muscles and their aponeurosis and a layer of fascia –the fascia transversalis –all overlying the peritoneum.
The ideal abdomen is formed by a proper relationship between the osteomuscular system, the subcutaneous adipose tissue, and the quantity of the overlying skin. This gives the aesthetic contour of prominences well visible by light reflexes, and depressions by shadows.
The term abdominoplasty covers a range of surgical procedures aiming at improving abdominal contour. In the past, operations on the abdominal wall reported at the turn of the century were aimed primarily at the relief of functional problems associated with hernias and large pendulous abdomens.
During the past decade, many combinations of operative techniques for abdominoplasty have evolved to suit the individual requirements of the patient. The purpose was to present a safe alternative to conventional abdominoplasty
In this study we compared between two different techniques of musculoaponeurotic plication.vertical only with vertical and horizontal together.
Plication of the anterior rectus sheath is the most popular way to deal with this muscular deformity.
The rectus sheath occupies more than 50% of the anterior abdominal wall(Lejour et al,1991) the large vertical plication reduces the sheath to 25% or less of the anterior abdominal wall.this leaves the abdomen oddly flat rather than perserving the native outline of the rectus sheath (John et al, 2004).
In order to restore the abdomen to more natural youthful shape retaining the bulges of the rectus muscle with a depression between them.also to gain maximum effect of waist line improvement and back pain relief.
The standard abdominoplasty technique uses a wide vertically oriented plication of the rectus sheath to narrow the waistline.this reduces the contribution of the rectus sheath to the anterior abdominal wall from more than 50 percent to 25percent or less and creates an unnaturally flat appearance.no amount of exercise can restore the native form of the rectus sheath.in the last few years the authors have performed a transverse plication of the external oblique fascia,to address vertical laxity,complemented by a bilateral crescent-shaped plication of the external oblique fascia,to address waistline contour.ten patients who underwent the transeverse rectus plication technique were compared with a similar group of patients who underwent vertical rectus plication.
Comparison was made via preoperative and post operative photographic analysis by two impatial judges.
Comparison includes aesthetic results (abdominal wall contour), waistline contour. Improvement of back pain. Complications of the technique, functional results (rehabilitation of the anterior abdominal wall and removal of abdominal wall hernias if small
Five areas affected by musculofascial plication were evaluated:Anterior abdominal contour,definition of the linea alba,definition of the linea semilunaris,waistline contour,and transposition from the hips to the waist.
In our patient population, we have consistently observed improved results with the transverse plication technique as compared with the traditional vertical rectus plication technique.The results of our comparison support this observation.
Finally patients seek abdominoplasty to restore a more youthful appearance to their abdomen as a whole.The modern abdominoplasty must address not only skin and subcutaneous tissue but also the muscular abdominal wall to maximize aesthetic outcome of the procedure.The fascial plication described provides provides both youthful concavity to the waistline and retains the native contour of the rectus muscle in the central abdomen. (John et al, 2004).