Umbilical reconstruction with an inverted C-V flap

Neo-Omphaloplasty within a Vertical Scar: The Double Trapezium Flap Technique

Background: Various techniques for neo-omphaloplasty (or umbilicoplasty/umbiliconeoplasty) have been established in recent decades. However, when the omphaloplasty must be integrated into a vertical scar, most of these techniques are unsuitable. Method: We established a technique comprising two "cross-border" trapezium flaps that come together in a key-lock fashion to be applicable for umbilical reconstruction in vertical scars. Between 2020 and 2023, we performed the double trapezium flap technique in 11 patients requiring abdominal wall correction due to previous operations resulting in the loss of the original navel and a vertical midline scar. The follow-up period was 12 months. Results: We encountered two minor wound healing disorders not involving the omphaloplasty. One patient experienced a more severe wound healing complication involving the vertical scar and the lower flap of the neo-umbilicus. No cases of umbilical flattening or detachment of the anchorage stitches were detected. Patients ranked the aesthetic outcomes as "excellent" (n = 9) or "good" (n = 2). Physicians ranked the results as "excellent" (n = 7), "good" (n = 4), and "average" (n = 1). Conclusions: For the selected patients, this technique appears to be a good and reliable option to create a natural looking neo-umbilicus, creating sufficient umbilical depth with minimal scarring. While a study population of 11 patients is hardly enough to endorse a new technique, appropriate cases are comparatively rare and very specific.

To Keep or Not to Keep? The Hamletic Umbilical Dilemma: Preservation versus Reconstruction of the Umbilicus in Vertical Abdominoplasty

(1) Background: The role of the umbilical scar and its repositioning remains one of the most important surgical steps in the execution of any type of abdominoplasty, including those involving "inverted-t" or "fleur de lys" incisions. A consequence of this is a surgeon's Hamletic dilemma: to keep or not to keep the original umbilical scar? (2) Methods: A retrospective observational study was conducted on all patients undergoing "T-inverted" abdominoplasty at the Department of Plastic Surgery of the Santa Maria alle Scotte University Hospital, Siena, between January 2018 and December 2020. Twelve months after the surgery we submitted to all patients the U-score questionnaire about their feelings about their umbilicus's appearance. Patients could assign a score from 1 (very dissatisfied) to 4 (very satisfied) to each of the five items of the score. (3) Results: The average of the scores attributed by the nine patients in whom the navel was preserved is 13 (Range 10-17), while in patients on whom a navel reconstruction was performed, the mean score is 16.8 (Range 12-20). The mean score of patients with a reconstructed umbilicus is, therefore, statistically higher than that of the other group of patients (t-value = 3.88, p = 0.000374) with an average increase of 3.8 points. (4) Conclusions: We can state that the reconstruction of a new navel is the right answer to the Hamletic dilemma in patients having undergone vertical or anchor abdominoplasty.

New Method for Umbilicoplasty with Bilateral Square Flap and Caudal Deep Inferior Epigastric Artery Perforator Flap

BACKGROUND

The navel is an important cosmetic feature of the abdomen. A vertically long navel with a deep caudal side has recently been preferred by patients. Currently, there is no plastic surgery technique for complete umbilical repositioning or plasty after umbilical keloid resection. This study aimed to examine the effect of a new umbilicoplasty by combining a bilateral square flap with a triangular flap that utilizes the excess caudal skin nourished by the deep inferior epigastric artery perforator.

METHODS

A total of 23 patients underwent umbilical keloid resection and new umbilicoplasty between April 2018 and March 2020. The mean patient age was 48.2 (range: 36-68) years, and mean body mass index was 23.1 (range: 18.5-33.4). Satisfaction with umbilical morphology was evaluated on a 5-point scale through interviews.

RESULTS

The surgery resulted in forming a vertically elongated deep caudal umbilical fossa. All patients were satisfied with their umbilical morphology (mean score, 4.6). In one case involving a woman who underwent breast reconstruction with a deep inferior epigastric artery perforator flap, superficial necrosis of the triangular flap was observed. However, no other complications were observed.

CONCLUSIONS

Creating a flap with stable blood circulation using the tissue originally excised during umbilical surgery allowed for the reproduction of a desirable umbilical morphology with adequate verticality and caudal depth.

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 .

Umbilical reconstruction: different techniques, a single aim

The umbilicus is a unique physiologic scar of human life resulting from the healing process of the cut umbilical cord at birth. Its absence leads to an unnatural abdominal appearance, and an abnormally shaped or misplaced umbilicus may draw undue attention to the central abdomen. Loss of the umbilicus can be an embarrassing deformity; this occurs when older techniques of umbilical hernia or incisional hernia repair are employed and after abdominoplasty, urachal cyst repair, omphalocele repair, gastroschisis repair, some tumor excisions, and mobilization of bipedicled or bilateral TRAM/DIEP flaps for breast reconstruction. Umbilicoplasty, in which the umbilicus remains anchored to the deep abdominal fascia but is transposed through a newly-formed aperture in the upper abdominal skin flap, is performed in abdominoplasty either for abdominal flap harvest or purely for aesthetics. On the other hand, umbiliconeoplasty describes the de novo creation of an umbilicus that is absent for either congenital or acquired reasons. The optimal umbilical reconstruction should be reliable, reproducible, aesthetically appropriate, and associated with low morbidity. Ideally, it is also single-staged, except in the case of an infected wound, in which case a delayed primary approach may be prudent. (www.actabiomedica.it)

Immediate Umbilical Reconstruction after a Mohs Micrographic Surgery for Primary Cutaneous Adenoid Cystic Carcinoma Arising in the Umbilicus

Adenoid cystic carcinoma (ACC) is a malignant neoplasm of glands commonly occurs in salivary glands. Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of ACC that primarily presents on the skin. Herein, we represent a rare case of PCACC occurred in the umbilicus in a 66-year-old Korean male patient. The patient visited our center with erythematous indurated patch on the umbilicus diagnosed as ACC by incisional biopsy at another center. The diagnosis of PCACC was confirmed by additional histopathologic examination and imaging study. We proceeded Mohs micrographic surgery and reconstructed umbilicus with tacked purse string suture. Local recurrence and distant metastasis were not observed during 30-month follow-up. We report this rare case of PCACC on the umbilicus so that dermatologist can aware of the rare disease. Furthermore, we recommend MMS and tacked purse string suture as effective methods for treatment of PCACC and immediate umbilical reconstruction.

'Scarless reverse umbilicoplasty': A new technique of umbilical transposition in abdominoplasty

INTRODUCTION

The navel plays a major role in the aesthetics of the abdomen. A navel that is abnormally shaped, malpositioned or has evident scarring may compromise the outcome of an otherwise well-executed full abdominoplasty. The aim of the technique in question is to recreate a navel that looks natural, with no visible scar, and that is properly positioned.

MATERIALS AND METHODS

The technique was performed in 147 abdominoplasties of patients of both sexes (123 females and 24 males), with an average age of 35 years and a mean BMI of 24 kg/m². The procedure involves the creation of a navel of reduced size, 10 × 5 mm, and its inset in the abdominal wall. Subsequently, the as-yet-not sutured abdominal flap is extended caudally to determine the point of projection of the navel. The abdominal skin is marked, the flap is reversed and an internal suture is carried out.

RESULTS

The appearance of the navel is aesthetically pleasant and natural looking and with no visible scarring. In addition, the position of the umbilicus is always correct. At the two-year follow-up, the results remain stable. No major complication occurred.

CONCLUSIONS

The technique allows for the attainment of an extremely natural looking navel that satisfies the aesthetic criteria of attractiveness without visible scarring. The navel is always correctly positioned, without requiring measurements during surgery. The procedure is rapid, and although it does require a short learning curve, the results are extremely aesthetically pleasing and reproducible. The patient satisfaction rate is extremely high.

Umbilical hernia: Influence of adhesive strapping on outcome

BACKGROUND

Adhesive strapping for umbilical hernia has been re-evaluated as a promising treatment. We evaluated the influence of adhesive strapping on the outcome of umbilical hernia.

METHODS

We retrospectively evaluated patients with umbilical hernia referred to the present institution from April 2011 to December 2015. Patients who were treated with adhesive strapping were compared with an observation alone group. The adhesive strapping group was also subdivided into two groups: the cure group and the treatment failure group.

RESULTS

A total of 212 patients with umbilical hernia were referred to the present institution. Eighty-nine patients were treated with adhesive strapping, while 27 had observation only. The cure rate in the adhesive strapping group was significantly higher than that in the observation group. The duration of treatment of the adhesive strapping group was significantly shorter than that of the observation group. In the adhesive strapping group, the patients in the cure group were treated significantly earlier than those in the treatment failure group (P < 0.001). Furthermore, even in cases of umbilical hernia non-closure, surgical repair was easier after adhesive strapping.

CONCLUSION

Adhesive strapping represents a promising treatment for umbilical hernia. To achieve the best results, adhesive strapping should be initiated as early as possible.

[Umbilicus in children]

The umbilicus is our first scar. It is the last remain of our life in utero. Besides the umbilical hernia, a common pathology during the first three years of life that rarely requires surgery, there are some rare congenital abnormalities such as gastroschisis and omphalocele, which occur in about 1-5/10,000 births. Gastroschisis is a birth defect of the anterior abdominal wall, through which the fetal intestines freely protrude and are not covered by any membranes. During the 13th week prenatal ultrasound, the umbilical cord can be seen to be properly attached while the intestines float freely in the amniotic fluid. This defect is most common in young women who smoke and/or use cocaine and is not typically associated with genetic disorders. Omphalocele is an average coelosomy, in which a visceral hernia protrudes into the base of the umbilical cord. Omphalocele is typically diagnosed during the prenatal phase, and occurs most commonly in older mothers. It is frequently associated with genetic and morphologic abnormalities, therefore a karyotype should automatically be performed. For these two pathologies, the surgical problem lies in managing, during the reintegration, the conflict container/content responsible to lower vena cava syndrome and disorders ventilatory. Deciding on the technique will depend on the clinical form, and on the tolerance to reinsertion. The success of the surgery is directly linked to the postoperative emergence care for the pre-, per- and postnatal phases. The umbilical cord is preserved in the case of a gastroschisis. A primary or secondary umbilicoplasty will be performed for an omphalocele closure. The umbilicoplasty aims to create an umbilicus in a good position by giving it a shape, ideally oval, but also and especially an umbilication. The primary or secondary umbilicoplasty remains a challenge in a growing abdomen (change in position, deformation, loss of intussusception with growth). Many techniques are described: cutaneous flaps randomly placed, excision and skin plasty, resection and controlled wound healing. The choice of technique is a matter of practice but must be done in a rational way, depending on the scar condition when secondary reconstruction, and with minimal scarring, for primary reconstruction. To avoid morphological changes associated with growth, secondary umbilicoplasty should be proposed after the age of five.

Double half-cone flap umbilicoplasty for proboscoid umbilical hernia in a 2 years old child with satisfactory results 2 years later

Surgical repair of large umbilical hernias may present a challenging surgical problem; standard surgical techniques have proven to be inadequate for both closing the fascial defect of the umbilicus and providing a satisfactory cosmetic result. We describe here a case of double half-cone flap umbilicoplasty that was performed in a 2 years old boy. The case of a 2 years old child with proboscoid umbilical hernia. The protruding umbilical skin was excised sharply by two V-shaped cuts leaving two half cones, a short cephalic (0.5cm) and a long caudal (1cm). A classic herniotomy was carried out, with repair of the facial defect. The caudal half cone was sutured from its apex till half it's length upon itself with interrupted sutures and it was anchored deeply to the fascia. Then we inverted the cephalic half cone which was sutured to the caudal cone to form the new umbilicus. The early result was excellent with no complications and the result after 2years revealed a cosmetically satisfactory shape of the umbilicus. this technique provides a good solution for reconstruction of the protruding umbilical skin and it is easy to learn, easy to be taught and perform in surgical environments and may be applicable for any kind of umbilical reconstruction.

The dome procedure: a new technique for the reconstruction of the umbilicus

PURPOSE

The absence of the umbilicus is, in essence, an aesthetic deformity of the abdominal wall. The goal of reconstructing the umbilicus is to obtain a natural, three-dimensional appearance. In this study, we present a new technique called the "dome procedure" for the reconstruction of the umbilicus.

METHODS

This procedure can be applied under local anaesthesia on an outpatient basis and the drawing of the design is simple. The technique was applied to six patients who presented with an absence of the umbilicus following repair of a large incisional and umbilical hernia.

RESULTS

No major or minor complications were encountered. Patient satisfaction was high after surgical intervention.

CONCLUSIONS

The dome procedure, which enables the umbilicus to have a natural appearance with sufficient depression and normal-appearing wrinkles, is simple, easy to perform, and safe.

Four flaps technique for neoumbilicoplasty

The absence or disfigurement of the umbilicus is both cosmetically and psychologically distressing to patients. The goal of aesthetically pleasing umbilical reconstruction is to create a neoumbilicus with sufficient depth and good morphology, with natural-looking superior hooding and minimal scarring. Although many reports have presented techniques for creating new and attractive umbilici, we developed a technique that we term the "four flaps technique" for creating a neoumbilicus in circumstances such as the congenital absence of the umbilicus or the lack of remaining umbilical tissue following the excision of a hypertrophic or scarred umbilicus. This method uses the neighboring tissue by simply elevating four flaps and can yield sufficient depth and an aesthetically pleasing shape with appropriate superior hooding.

Umbilical reconstruction using a modified inverted C-V flap with conjoint flaps

The umbilicus is an important aesthetic feature of the abdomen. Because of its location, the umbilicus can be injured after abdominal surgical procedures. Various methods have been devised to reconstruct the umbilicus by using local flaps, purse-string sutures, or a cartilage graft, but there are no ideal methods. The authors have created a modified inverted C-V flap with conjoint flaps. A 10-year-old boy presented with deformed umbilicus because he had undergone surgical correction of an omphalocele. The drawback of the traditional C-V flap method is the transverse long abdominal scar because of the long length of the V flap. However, by using two conjoint flaps at the superior part of the C-V flap, the length of V flap can be more short and the umbilical wall can be reconstructed by rotation of two conjoint flaps. It is also good for making a sinusoidal pocket and it makes the umbilicus deeper and more natural-looking. After the operation, there were no complications like flap necrosis, infection, haematoma, and so on. The patient was satisfied with the results The patient had a more attractive umbilicus than the one with the other previous technique. This new method makes a natural-looking umbilicus with less of a transverse scar and an adequate sinusoidal pocket and umbilical wall.

Reconstructing a natural looking umbilicus: a new technique

An attractive umbilicus is an essential component of the abdominal wall. It defines the midline abdominal sulcus and adds to a shapely abdominal curvature. Certain procedures place the umbilicus at risk thus providing a need for a neoumbilicus. Three-hundred and twenty cases of abdominoplasties, panniculetomies, and TRAM flaps for breast reconstruction were reviewed. Five patients underwent an umbilical reconstruction after loss of the native umbilicus. A crescent-shaped incision was used to create an inferiorly based skin flap. The flap was inset to the abdominal fascia. A small full-thickness skin graft was used to form the superior hood. All patients attained an esthetically pleasing umbilicus with minimal scarring. No contracture, flap necrosis, or graft loss were noted. We present a novel, simple, and reliable technique of umbilical restoration. It circumvents the need for external scars and allows for achieving a naturally appearing umbilicus.

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.

A simple new technique for neo-umbilicoplasty

This article describes a new technique for reconstruction of the umbilicus. The technique used simply originated from a few clinical cases in which we were confronted with an absent or destroyed umbilicus. Previously described techniques for neo-umbilicoplasty were unsatisfying or seemed too complex in our hands. We introduce this easy, safe and reproducible technique which in our experience resulted in a very acceptable newly formed umbilicus.

[Umbilical reconstruction in children. Prospective report of 77 cases]

Umbilical hernia is as frequent pathology in our country. The skin excess is a real problem for the surgeon because it is inesthetical. We report 77 cases of children with umbilical hernia who we operated between 1999 and 2000. Fifty-five of them have a umbilical plasty. For this, we used three surgical techniques: lateral left plasty, "horseshoe" plasty and umbilical graft. We classed our results into three groups: 40 good results, seven middle results and three bad results. Twenty-seven patients are lost. These three surgical techniques are a simple and safe solution to this problem of skin excess in the umbilical hernia.

Umbilical reconstruction after repair of large umbilical hernia: the "lazy-M" and omega flaps

A simple and easy-to-perform technique of umbilical reconstruction after repair of a large umbilical hernia is described. Two opposing skin flaps, an upper inverted Omega shaped flap, and a lower, lazy M-shaped flap were designed to create a deep, 3-dimensional, normal-appearing umbilicus in identical twins.