Rectus Diastasis With Midline Hernias: Abdominal Wall Reconstruction With Autologous Tissue

Summary: Surgical intervention is recommended for patients presenting with ventral hernias accompanied by rectus diastasis. The priority goals of reconstruction are to restore normal abdominal wall anatomy and to minimize the risk of recurrence. Despite the availability of various surgical techniques, recurrence remains a significant concern for surgeons. This report presents the authors’ experience with abdominal wall reconstruction using autologous tissue. This surgical technique is indicated for patients presenting with a midline hernia with severe rectus diastasis (defined by an inter-rectus distance >5 cm). Initially, a conventional abdominoplasty was performed in combination with rectus abdominis muscle plication. The excised tissue was subsequently processed into dermal graft sheets through de-epithelialization and defatting using surgical scissors. These dermal sheets were then sutured to the abdominal aponeurosis to reinforce the repair. Wound closure was achieved using a tension-reducing technique to optimize healing and reduce postoperative complications. All patients were discharged uneventfully. Follow-up evaluations demonstrated favorable functional and aesthetic outcomes. Computed tomography performed 6 months after surgery revealed the contour of the transplanted dermal sheets, providing evidence supporting the effectiveness of dermal sheet reinforcement. Based on our experiences, for patients with fascia-based defects, particularly those with severe rectus diastasis associated with a midline hernia, this technique represents an efficient, cost-effective, and reliable reconstructive option.