Neoomphaloplasty: An old and new technique

Umbilical Reconstruction Techniques: A Literature Review

BACKGROUND

There are many instances in which sacrificing the umbilicus is unavoidable. Umbilical reconstruction (umbiliconeoplasty) is an important surgical procedure to complete the abdomen's reconstruction and to give again a pleasant cosmetic appearance.

OBJECTIVES

To provide a complete overview of all surgical techniques for umbiliconeoplasty described in the literature.

METHODS

PubMed database was queried using 'umbilical and reconstruction', 'umbilicus and reconstruction', 'navel and reconstruction', 'umbiliconeoplasty', 'neo-omphaloplasty' or 'umbilicaneoplasty' to select the papers dealing with the reconstruction of the umbilicus.

RESULTS

Sixty different techniques for the reconstruction of the missing umbilicus were described in 77 papers. Local skin flaps and the purse-string suture technique were the most frequently described techniques. The Three flaps technique, the Four flaps technique and the 2 Lateral rectangular pedicle lateral flaps technique were the most popular local flap techniques. Indications ranged from congenital pediatric defects to reconstruction during abdominoplasty.

CONCLUSIONS

Several surgical techniques were described for umbilicus reconstruction. While there is not a universal algorithm for the choice of the technique, the surgeon may decide which technique to use based on other surgeons' experiences reports.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A new umbilical reconstruction technique used for 306 consecutive abdominoplasties

BACKGROUND

The search for a natural-appearing umbilicus that does not compromise the aesthetic outcome of abdominoplasty began in the 1950s and coincides with the period that saw increasing exposure of the female body. Since then, umbilical transposition has been favored by most surgeons.

METHODS

This report describes a new technique for umbilical reconstruction using a small X-shaped incision that creates four V-shaped flaps, which are sutured to the aponeurosis with absorbable sutures. This technique was used for 306 consecutive abdominoplasty patients, and a survey was performed to determine their level of satisfaction with the surgical outcome.

RESULTS

A natural-appearing new umbilicus was created with no visible scars, a low complication rate (9 %), and a high level of patient satisfaction.

CONCLUSIONS

The described technique had a low complication rate and allowed the creation of a new umbilicus with a natural appearance in a rapid, safe, and simple manner.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article.

Determining anatomical position of the umbilicus in Iranian girls, and providing quantitative indices and formula to determine neo-umbilicus during abdominoplasty

BACKGROUND AND AIM

The umbilicus plays an important role in the aesthetic appearance of the abdomen. So, its restoration during reconstructive surgeries, such as an abdominoplasty, is a challenge. The aim of this study was to evaluate quantitative indices based on constant skeletal points in the anterior wall of abdomen in order to provide an appropriate site of a neo-umbilicus during an abdominoplasty.

MATERIALS AND METHODS

In this descriptive, cross-sectional study, we enrolled 65 young adult girls (20-25 years old) who were nulliparous, nulligravid, and without any history of surgery. Weight, height, distance from xiphoid to umbilicus (Xu), distance from the pubic symphysis to xiphosternum (Xp), and anterior superior iliac spine (interASIS) distance of the subjects were measured. Data were analysed by SPSS ver. 16 using descriptive statistics and multiple regression tests in order to present a formula (equation).

RESULTS

Mean age was 22.74 ± 1.51 years, mean weight 54.98 ± 6.51 kg, mean height 160.91 ± 4.11 cm and body mass index (BMI) was calculated to be 21.25 ± 2.61 kg/m(2). Mean Xp distance was 32.26 ± 2.23 cm and mean Xu distance was 17.11 ± 1.64 cm. Xu/Xp ratio (ratio of umbilicoxiphoid distance to puboxiphoid distance) was 53.06 ± 3.9%. Data were analysed using multiple regression test and likelihood ratio. The formula used in determining the appropriate site of neo-umbilicus during abdominoplasty was suggested: Xu=-0.98 + 0.91Xp - 0.07H.

CONCLUSION

By applying these quantitative methods, the natural site of neo-umbilicus could be determined. This may reduce practice errors and increase patient satisfaction. In addition, these findings provide plausible evidence to defend against possible legal complaints.

Umbilical reconstruction for patients with a midline scar

The authors describe an approach to neo-umbilicoplasty for patients with vertical midline scars and those who have undergone extensive tegumental resections after bariatric surgery. Two lateral pedicle flaps sutured to each other are used to shape a cutaneous wall tube in which the inverted end is anchored to the aponeurotic plane. A navel cavity of adequate scoop is shaped with no surrounding scar, in addition to relief of the strain along the vertical scar, which will be less prone to hypertrophy and will have a better cosmetic appearance. This article presents seven cases of umbilical reconstruction using this technique.

Reconstruction technique for umbilical endometriosis

OBJECTIVE

To present a technique for immediate umbilical reconstruction in women undergoing resection of umbilical endometriosis.

METHODS

Umbilical reconstruction using 2 semicircular defatted skin flaps was performed in 7 patients surgically treated for umbilical endometriosis from October 2000 to June 2004. The patients were followed up for at least 6 months.

RESULTS

Anatomical aspect, depression, and abdominal wall scar were considered satisfactory, although hypertrophic umbilical scars developed in 2 patients.

CONCLUSION

This technique using 2 semicircular defatted flaps is efficient in creating a new umbilicus with a natural appearance while leaving a minimal scar. Moreover, it allows for laparoscopic inspection of the abdominal cavity.

Refinements in abdominoplasty

When performing traditional abdominoplasty, three fundamental defects of the abdominal wall must always be addressed by the plastic surgeon. They include redundant skin, excess fat, and musculofascial laxity. Plastic surgeons have found that this procedure consists of dermolipectomy and rectus plication, extremely effective in restoring the abdomen to its youthful shape in the vast majority of patients. This article will review the recent advancements in body contouring surgery while focusing on the recent technical refinements in abdominoplasty.

Umbilical reconstruction in patients with exstrophy: the kangaroo pouch technique

PURPOSE

Before the current attitude of umbilical preservation and transposition at bladder closure in patients with exstrophy the navel was systematically removed. Many patients without an umbilicus complain about this deformity. We report a simple technique of umbilical reconstruction using a rectangular skin flap fashioned as a kangaroo pouch.

MATERIALS AND METHODS

Four patients 10 to 20 years old with exstrophy underwent this procedure. A small cutaneous pouch was fashioned by folding a vertical rectangular skin flap and the pouch was anchored deeply to the rectus fascia. A compressive dressing was packed into the new umbilicus and left in place for several days.

RESULTS

The 4 patients have an excellent cosmetic result with adequate location, good morphology and sufficient depth at a mean followup of 8 months (range 6 to 11).

CONCLUSIONS

Our technique of umbilical reconstruction is easy to perform and provides good mid-term cosmetic results. This technique is particularly adapted for patients with exstrophy who often require external genital reconstruction at the same time.