MAY 2022 | The Surgical Technologist | 219 869 Hernia (2021) 25:863–870 13 the mesh in the axial (or transverse) plane. Large unfixed polypropylene meshes up to 24 cm wide [18] do indeed provide tissue support, but any decrease in circumference of the abdominal wall requires that all of the tightening occur at the medial border of the rectus muscles where excessive tension may lead to suture pull-through. Large unfixed meshes do not decrease the width of a post-partum rectus muscle (the dissection and tension at the midline could theoretically widen the muscle), nor do they create an emphasis of the semilunar line. Alternatives to mesh abdominoplasty include suture plications that may result in suture pull-through, minimally invasive techniques that do not generate high tension in the axial plane across the mesh and do not involve the excision of skin, and overlay meshes that are fixated with multiple sutures but are prone to seroma formation. Placement of transfascial sutures is not a widely performed technique, perhaps for the presumed difficulty involved in placing the sutures while avoiding intercostal nerves and the deep inferior epigastric artery. While short-term pain typically requires a hospitalization, long-term pain has not been an issue for these patients, though one patient required physical therapy at 6 months. If chronic pain were to develop, treatment would involve intercostal nerve excision and allograft reconstruction [19]. This has not been necessary to date. In our hands, a mesh abdominoplasty using a wellfixed retromuscular mesh is associated with low SSO and a durable improvement of abdominal shape and contour in both men and women. Technical details in placement of the mesh construct may be an important factor in achievement of these outcomes. Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10029-021-02461-1. Funding None. Declarations Conflict of interest Dr. Dumanian has intellectual property in MSi, manufacturer of Duramesh Suturable Mesh. Strips of mesh used as a suture in an off-label manner are mentioned in this manuscript. No other conflicts exist for Dr. Dumanian or Dr. Moradian. Table 3 Data from 56 patients undergoing retrorectus mesh repair with a well-fixed narrow mesh Demographic characteristics Sex Male Female Total no. of mesh abdominoplasty patients 16 40 Age (mean, range) 57 (35–74) 42 (29–70) Clinical characteristics Mesh abdominoplasty (n =16) Mesh abdominoplasty (n =40) BMI (kg/m2) (mean, range, standard deviation) 29 (24–37) (4.0) 26 (18–40) (5.3) Smoking status Current (n, %) 2 (12%) 0 (0%) Former (n, %) 1 (6%) 0 (1%) Never (n, %) 13 (81%) 40 (95%) Diabetes Yes (n, %) 3 (19%) 0 (4%) No (n, %) 13 (81%) 40 (96%) Concomitant hernia (patients) (n) Epigastric 9 9 Umbilical 7 13 Width of rectus diastasis (cm) (mean, range) 6 (2–8) 7 (4–15) Follow-up visits in first 6 months (mean, range) 2 (1–6) 3 (1–7) Hospital stay (days) (mean, range) 2.5 (0–5) 2.5 (0–6) SSI (n, %) 2 (12%) 1 (3%) SSO (n, %) 0 (0%) 0 (0%) Other complication Drain site erythemia, infected mesh strip knot at umbilicus 6 months after procedure Superficial suture abscess, resolved with dermal knot removal and antibiotics Hospital readmission (n, %) 0 (0%) 0 (0%) Muscle revision (n, %) 0 (0%) 1 (3%) Office soft tissue revision (n, %) 1 (6%) 9 (23%) Follow-up 73 weeks 45 weeks
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