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Improving tension decrease in components separation technique

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Abstract

Purpose

The purpose of this study is to evaluate the tension at the aponeurotic edges after the undermining of the anterior rectus sheath associated with the classic components separation in cadavers.

Methods

Twenty fresh adult cadavers were placed supine and an incision in the anterior rectus sheath was done, thus exposing the posterior sheath. The two levels to be studied were marked 3 cm above and 2 cm below the umbilicus. An analogical dynamometer was used to measure the traction values, consecutively during four stages as follows: initial stage, no aponeurotic undermining; Stage 1, separation of the anterior rectus sheaths; Stage 2, after Stage 1 the external oblique aponeurosis were incised along the semilunaris and the external oblique muscles were undermined; Stage 3, after Stage 2 rectus muscles were completely separated from their posterior sheaths. Statistical analysis was done by Friedman’s analysis of variance (p < 0.05).

Results

There was a progressive and significant decrease in tension along the stages (Friedman’s analysis of variance, p < 0.001). Traction indexes were higher in the initial stage and became gradually lower along the other stages.

Conclusion

The undermining of the anterior rectus sheaths helps to decrease tension during the components separation technique.

Level of evidence

Level V, experimental study.

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Conflict of interest

The authors declare that they do not have any commercial interest in the subject of study and they also do not have any source of financial or material support.

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Authors and Affiliations

  1. Division of Surgery, University of Franca, R: Padre Anchieta, 1128, Centro, Franca, SP, 14400-740, Brazil

    M. V. J. Barbosa

  2. Division of Plastic Surgery, Federal University of São Paulo, R: Napoleão de Barros, 715, 4º Andar, São Paulo, SP, 04024-002, Brazil

    N. A. M. Ayaviri & F. X. Nahas

  3. Federal University of São Paulo, R: Napoleão de Barros, 715, 4º Andar, São Paulo, SP, 04024-002, Brazil

    Y. Juliano

  4. Chairwoman of the Division of Plastic Surgery, Federal University of São Paulo, R: Napoleão de Barros, 715, 4º Andar, São Paulo, SP, 04024-002, Brazil

    L. M. Ferreira

Authors
  1. M. V. J. Barbosa
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  2. N. A. M. Ayaviri
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  3. F. X. Nahas
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  4. Y. Juliano
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  5. L. M. Ferreira
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Corresponding author

Correspondence to M. V. J. Barbosa.

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Barbosa, M.V.J., Ayaviri, N.A.M., Nahas, F.X. et al. Improving tension decrease in components separation technique. Hernia 18, 123–129 (2014). https://doi.org/10.1007/s10029-013-1094-7

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  • DOI: https://doi.org/10.1007/s10029-013-1094-7

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