867 Hernia (2021) 25:863–870 13 all of the mesh is covered by the rectus muscles. Figure 1 and Video 1 demonstrate the preoperative rectus diastasis in a slender woman. Figures 2, 3, 4, 5 and 6 illustrate the technical steps of a mesh abdominoplasty through a vertical incision (it is easier to photograph the technical details when the skin is fully elevated in this manner). Figures 7 and 8 illustrate the long-term results possible. Results Results are presented in Table 3. Of note is the low rate of smoking in these patients, the average width of the rectus diastasis of 6–7 cm, a 2.5 day hospitalization, and 2–3 clinic visits in the first 6 months after surgery. There was a 0% SSO rate, though three patients had superficial infections that resolved with either oral antibiotics or the removal of a mesh strip knot as an office procedure 6 months after the procedure at the site of a Fig. 3 Mesh completely inset, just before closure of the medial border of the rectus muscles. The laterally placed sutures serve to narrow the rectus muscles and emphasize the semilunar lines Fig. 4 Skin is excised both medially and inferiorly. Staples are placed prior to the initial incision as landmarks so that skin is excised equally from both hemiabdomens. “Pumpkin-teeth” flaps are drawn. A drawn line on the skin is the xyphoid Fig. 5 “Pumpkin-teeth” flaps are tacked down to the abdominal wall as first step in creating a neo-umbilicus Fig. 6 Early post-operative appearance MAY 2022 | The Surgical Technologist | 213
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