diastasis recti: Floppy Wall
Floppy Wall: what is it
More correctly referred to asPFAD(postpartum floppy abdomen diastasis).
It is a form of diastasis recti resulting from pregnancies where the rectus muscles are hypotonic, elongated and thinned in their thickness.
This occurs (to varying degrees) in almost all clinically relevant postpartum diastases and occurs because of the pathophysiology of the disease itself.
Therefore when speaking of the so-called "floppy wall" , we do not refer to a pathology in its own right, but allude to a more or less represented feature of a postpartum diastasis.
Superficial layers such as the panniculus adiposus and skin also often show signs of distress, hypotrophy, and sagging. In addition, the significant weakening of linea alba often results in considerable IRD (Inter Recti Distance)and the presence of multiple midline hernias.
What is it caused by?
It is created slowly and gradually during the nine months of pregnancy due to large increases in volume, often in twin pregnancies or in cases of polyhydramnios (excessive amniotic fluid formation).
Generally, one does not notice the onset of this condition for the entire duration of pregnancy, but then at the time of delivery, the abdominal wall deters by remaining hypotonic, allowing rectus abdominis diastasis associated with the typical loss of muscle thickness and tone to show through, in addition to the conspicuous skin distress.
The very pathophysiology of diastasis makes the rectus muscles disconnected from each other making the abdominal wall lose its restraining effect and preventing it from generating adequate tension during the contraction phase.
Muscle contraction during movements still occurs but is ineffective and untraining. This over time prevents the rectus muscles from returning to optimal length, width, and trophism, despite 'even intense training.
How is it treated?
Therapy should include reconstruction of diastasis recti (which is the basis of this pathological condition).
The ideal reconstruction should be as faithful as possible to the 'original anatomy by recreating a newlinea alba in an"orthotopic" position (i.e., in the same position as it was originally).
To achieve this we generally preferR-TAPP reconstructions,
muscle realignment is done in total respect of anatomy by reconstructing the linea alba in orthotopic position thanks to a well-balanced suture on the margin medial(central) rectus muscles.
This creates the basic precondition for the rectus muscles to generate an appropriate and training contraction dynamic once activated.
Thus, the state of poor muscle utilization established by the pathology isreversedtoward a daily training stimulus for the contractile fibers. Over time, there is thusa natural recovery of the trophism and size of the rectus muscles.
This all results in additional late flattening of the abdomen, in addition to that already achieved in the immediate postoperative period by diastasis closure.
This recovery phase requires training on the part of the patient andmay not be fast , but the muscles have great capacity to respond and react positively even in advanced cases.
Sometimes in cases even more compromised by pathology the goal of "ideal flatness" is only partially achieved despite diastasis closure and training. However, the limitations of the human physique must be considered, but in any case, anatomical reconstructions are the only logical ones and represent the safest and most body-friendlypath.
For the treatment of surface aspects such as large amounts of excess skin and irregularities of the panniculus adiposus, in the same operating session we used to combine if necessaryextensive dermolipectomies, skin lifting, liposculpture and lipofillling to give the right tension to the skin and reshape the subcutaneous plane.
What to avoid!
We categorically consider so-called "corset" abdominoplasties to be avoided because they do not really allow the rectus muscles to be shortened (as improperly described by some). Such procedures only corrugate their anterior tendon surface without any efficacy on the muscle contractile fibers or evensometimes irreparablydamaging them.
The rectus muscles therefore cannot really be "shortened" surgically, Thetrue "shortening" of the rectus muscles as well as the resumption of their proper trophism is possible only and exclusively through their natural training in the context of proper midline anatomy (thus repairing in the most anatomical way possible only the diastasis without further sutures outside the midline).
Abdominoplasties a "corset"can therefore only give the initial impression of giving a certain shape to the abdominal part, but in reality it is a fictitious and nonfunctionalimpression.
In the long term then such procedures (now fortunately in disuse),can paradoxically result in pictures of fibro-adipose weakening or degeneration of the muscles as we can see in this case from another facility.
We therefore recommend interventions that are as anatomy-friendly as possible combined with appropriate training, avoiding nonsensical shortcuts that are often ineffective or potentially dangerous.
