Abstract
OBJECTIVES:Interest in elucidating the etiology of hernias has encouraged countless studies of musculoaponeurotic structures in individuals with and without hernias. Studies of hernia patients have firmly demonstrated a correlation between hernias and collagen alterations in their fascia. Diastasis recti is an increased width of the abdominal midline that is exclusively composed of interlacing aponeurotic expansions of the anterolateral abdominal muscles. The condition is common among women undergoing abdominoplasty, and many factors, not only mechanical, play a role. The goal of this study is to evaluate and compare collagen type I and III levels in the midline fascia of women with and without diastasis recti to report their possible influence on this condition.METHODS:This is a case-control study nested within a surgical cohort of 18 women with diastasis recti and 18 women without the condition (cases and controls, respectively). Fascia from the midline of the abdominal wall was collected and analyzed through immunohistochemistry using polyclonal antibodies to collagen type I and III.RESULTS:Both type I and type III collagen were less abundant in women with diastasis recti than in those without the condition, and the difference was statistically significant (p<0.001).CONCLUSION:Low collagen type I and type III levels in the midline of the abdominal wall may play a key role in the development of diastasis recti.
Highlights
The anterior abdominal wall and its structures have been the subject of countless studies
BMI, body mass index, SU, supraumbilical; IU, infraumbilical; kpixels, pixels  1000; C-III, type III collagen; C-I, type I collagen. p, p-value. aStudent’s t-test. banalysis of covariance adjusting for potential effects of age and BMI
Many studies have focused on collagen, and the association between this protein and the etiology of hernias has been described extensively
Summary
The anterior abdominal wall and its structures have been the subject of countless studies. The midline, which comprises interlacing aponeurotic expansions of abdominal anterolateral muscles, is identified and visualized during the classic abdominal dermolipectomy. The surgery enables observation of the broad variation between the anatomy of the linea alba and abdominal protrusion in these patients. The myoaponeurotic layer of the anterior abdominal wall plays a key role, both functionally and aesthetically. The linea alba, region of the abdominal wall comprised of aponeurosis and without muscular covering, is exposed to the full intraabdominal pressure, and its resistance is a crucial factor in the abdominal contention. To understand factors that may explain failure of abdominal wall correction and containment, some studies note that deformities in the myoaponeurotic layer of the anterior
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