The correction of the diastasis of the rectus abdominis muscle concomitant with a moulded silicone implant insertion in a patient with medial pectus excavatum

Abstract

The association of the diastasis of the rectus abdominis muscle (DRAM) and the medial pectus excavatum (PE) was reported. We have been using soft silicone block, sculpted intraoperatively, to correct PE. The horizontal access used, 2 cm at a subxiphoid position, allows us to expose the sternum and the rectus abdominis muscles (RAM). We report a case, male, 31 years presenting medial PE and supraumbilical DRAM with a width of 35 mm at the costal arches, and 27 mm at 6 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches. The necessary space for the implant was dissected and the block was sculpted. The medial and superior aponeurosis borders of the RAM were incised at 6 cm from the xyphoid, and the posterior border of the RAM was released. The aponeurosis borders were brought together, promoting a medial and anterior positioning of the RAM. The inferior border of the implant was attached to the raw superior borders of the RAM. The result was considered satisfactory, and a magnetic resonance image 14-months after showed continuity of the implant and the muscles, promoting a uniform body contour.