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 .

Onfaloplastia: o retorno ao processo natural / Omphaloplasty: back to the natural process

INTRODUÇÃO: Desde do início da abdominoplastia moderna, os cirurgiões têm focado sua atenção na estética do umbigo. Relatos mostram os esforços realizados para recriar um aspecto natural do umbigo, sendo que diversas técnicas têm sido descritas, publicadas, e utilizadas pelos cirurgiões. Este estudo, imitando o processo de cicatrização natural do umbigo de um recém-nascido, apresenta outra perspectiva em relação a essa abordagem cirúrgica. MÉTODO: Os dados foram coletados entre 2008 e 2012. Nosso estudo inclui 103 pacientes, idade variando de 19 a 52 anos, submetidos a abdominoplastia e reconstrução do umbigo por meio da técnica imitando o processo de cicatrização natural do umbigo. Após resseção do excesso de pele do abdome e replicação, o retalho é posicionado corretamente, e uma incisão vertical de 2 cm é realizado no retalho para acomodar a nova posição do umbigo. Após um nó feito ao redor da pedúnculo a extremidade do umbigo é amputada. Finalmente, o umbigo é fixado nos quatro pontos cardinais da derme com sutura intradérmica, portanto, iniciando processo secundário de cicatrização. Em cerca de três semanas no período pós-operatório, a cirurgia é concluída e o efeito anatômico natural desejado é alcançado. CONCLUSÃO: A facilidade para realizar o procedimento e o aspecto final jovial do umbigo ao longo prazo torna o procedimento apropriado para as abdominoplastias.

INTRODUCTION: Since the beginning of modern abdominoplasty, plastic surgeons have fixed their attention on the aesthetic aspect of the umbilicus. Reports show the efforts made to recreate a natural looking belly button and several techniques have been described, published, and put to use by surgeons. The author, imitating the course of action of the navel's natural healing process of a newborn child, presents another perspective in this surgical field. METHOD: Results were collected between year 2008 to 2012, with patients ranging from 19 to 52 years of age, making a total 103 patients who were submitted to abdominoplasty and navel reconstruction under the technique proposed in this article. After the abdominal skin excess resection and rectiplication, the skin flap is correctly positioned, and a 2 cm vertical incision on the skin flap is performed to fit the new umbilicus position. Afterward a knot is made around the stalk and the extremity of the umbilicus is amputated. Finally the umbilicus is fixated in four cardinals points to the dermis of the skin incision with buried stitches and a secondary healing process begins. After about three weeks of postoperative period, the surgery concludes with the desired natural anatomic effect. RESULTS: The umbilical shape and scar had a natural, clean aspect, leaving aside the common stigmata usually found after abdominoplasty such as noticeable scar, widening, stenotic appearance, etc. CONCLUSION: The easy procedures and the final long-term youthful aspect of the umbilicus, make it suitable for the abdominoplasties armamentarium.

Análise retrospectiva de pacientes pós-bariátrica submetidos à abdominoplastia com neo-onfaloplastia: 70 Casos / Retrospective analysis of 70 patients who underwent post-bariatric abdominoplasty with neo-omphaloplasty

Introdução: Com o crescente aumento do tratamento cirúrgico da obesidade, surge para o cirurgião plástico um grupo de pacientes com grande flacidez cutânea após perda ponderal. Para aqueles submetidos à gastroplastia redutora convencional ou aberta, a abdominoplastia vertical, em âncora ou em T invertido, tem sido largamente utilizada para a melhoria do contorno abdominal, e no presente trabalho foi associada à amputação umbilical seguida de neo-onfaloplastia. Método: Foram operados 70 pacientes, com peso estável há no mínimo 18 meses, procedentes do ambulatório de Cirurgia Plástica da UNICAMP, no período de março de 2011 a abril de 2013. Em todos foi utilizada a técnica de abdominoplastia em âncora com exérese do umbigo original, juntamente com a peça cirúrgica e confecção de neo-umbigo, através de retalhos dermo-gordurosos bilaterais. Procedeu-se à análise retrospectiva dos prontuários médicos e arquivo fotográfico dos mesmos. Resultados: Nos 70 pacientes operados, houve predominância do sexo feminino (91%) e da raça branca (83%), com média de 40 anos. Após tempo de espera de aproximadamente 16 meses, foram submetidos à abdominoplastia em âncora associada a neo-onfaloplastia, que durou em média 2 horas. Observaram-se complicações pós-operatórias em 29,85% - deiscências pequenas, cicatrizes inestéticas, alargadas ou hipertróficas, queloides, seromas, excessos dermo-gordurosos relevantes e infecção de ferida operatória. Os neoumbigos obtidos são muito semelhantes aos umbigos originais. Não observamos necroses, estenoses, distorções morfológicas e nem mau posicionamento dos mesmos. Conclusão: Esta técnica tem permitido a obtenção de umbigos com aspecto natural, é de fácil execução e reduz o tempo operatório.

Introduction: With the increasing surgical treatment of obesity, a new group of patients is being attended by plastic surgeons: those with large flaccid skin following weight loss. For patients treated with conventional or open bariatric surgery, vertical, anchorline, or inverted "T" abdominoplasty has been widely used to improve the abdominal contour. In this study, abdominoplasty was associated with umbilical amputation followed by neo-omphaloplasty. Methods: Seventy patients with stable weight for at least 18 months underwent surgery at the UNICAMP Plastic Surgery Outpatient Clinic, from March 2011 to April 2013. In all patients, anchor-line abdominoplasty with excision of the original navel was executed, together with the surgical specimen and preparation of neo-umbilicus, through bilateral dermal-fat flaps. A retrospective analysis of medical records and photographic archives was performed. Results: The 70 patients were predominantly female (91%) and white (83%) with a mean age of 40 years. After a wait time of approximately 16 months, they were subjected to anchorline abdominoplasty associated with neo-omphaloplasty, which lasted an average of 2 hours. There were post-operative complications in 29.85% of the patients, including small dehiscence, unsightly, enlarged, or hypertrophic scars, keloid, seroma, relevant dermo-fatty excesses, and wound infection. The neo-umbilicus obtained from the surgery is very similar to the original umbilicus. We did not observe necrosis, stenosis, morphological distortions, or bad positioning. Conclusion: This technique has made it possible to obtain an umbilicus with a natural look, is easy to perform, and shortens operating time.

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.