Assessment of Superficial Fascia and Abdominal Fat of Anterior Abdominal Wall using Computed Tomography: A Retrospective Study

Abstract

Introduction: The advancements in technologies have created new promenade pertaining to the anatomy of the anterior abdominal wall and body contouring surgery. This kindle the anatomist and surgeon to redefine the anatomy of the anterior abdominal wall. Anterior abdominal wall was routinely tutored as two layers, but the controversy regarding the existence and extent prevails. From the literature search, it was evident that preservation of Scarpa’s fascia is the pivot in determining the outcome of abdominal surgeries. Aim: To document the existence and extent of the Membranous Fascia of Scarpa (MFS) and compare the abdominal fat between age and sex-matched Computed Tomography (CT) images at 3 levels i.e., i) L1 vertebrae, ii) umbilicus and iii) anterior superior iliac spine and also to compare the distribution of abdominal fat. Materials and Methods: This retrospective cross-sectional study was conducted in collaboration with the Department of Radiology at Sri Manakula Vinayagar Medical College and Hospital, Puducherry, from November 2019 to December 2020. A total of 60 CT images, that were age and sex matched were collected from the Medical Records Department. Data were analysed using Statistical Package for Social Sciences (SPSS) version 24.0 for windows. Types and extent of fascia were expressed in percentage, fat distribution as mean. The difference in mean between two and three independent groups was made using the Student’s t-test. The statistical tests applied were two tailed and p-value<0.05 were considered significant. Results: Single layer of the MFS was observed with 93.3%, 76.7% at level 1; 53.3%, 66.7% at level 2, 70%, 63.3% at level 3, among CT images of male and female respectively. The findings supported the presence of MFS on the entire anterior abdominal wall and 8 different patterns of MFS were observed. The anterior abdominal wall showed three layers of superficial fascia, with superficial fatty, MFS, and deep fatty zone. On comparing the abdominal fat, superficial fat was significantly high among females at all three levels. However, the deep fat though high among females in all the three-level; it was significantly high only at levels 1and 2 among subgroup 1 (p-value=0.003 and 0.001 respectively) and level 1 of subgroup 3 (p-value=0.01). Conclusion: The study decipher 3 layer theory of superficial layer of the anterior abdominal wall and superficial fat was significantly high among females, supporting that gender to be high-risk for surgical intervention. Redefining anatomy would guide for better and fruitful outcomes in surgical interventions.