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.

Reduction Umbilicoplasty: A Simple and Effective Method

Many ideal definitions have been proposed about the desirable shape and position of the appealing umbilicus. The attractive umbilicus is a moderately small umbilical size with an overall vertical orientation We would like to propose a new, simple and effective technique to correct a abnormal distorted large protruding umbilicus which developed on a 43 year-old man who undergone previous surgery. A inner circle 1cm in diameter, which was generally considered as a normal size, was drawn in the center of deformed umbilicus. Another outer circle, which was drawn between normal abdomen and deformed umbilicus, was horizontally divided into 2 portions. The upper portion of the outer ring was excised down to the dermal area and lower portion was deepithelized. The inner circle flap was meticulously defatted down to the abdominal wall fascia. Then, this inner circle was fixed to the fascia with 3-0 monofilament sutures at 3,9,12 o'clock direction for making a superior hood. Remnant outer circle was closed primarily with adjacent proper undermining. The natural looking umbilicus was shown until postoperative 2 weeks. A longitudinal deep umbilical depression was cosmetically pleasing. This new method of reduction umbilicoplasty is a safe, simple, and effective technique for aesthetically pleasing umbilicus.

Reduction Umbilicoplasty for Bizarre Big Umbilicus after Abdominoplasty

A cosmetically pleasing shape of the umbilicus is essential, especially in aesthetic operation. Umbilical restoring should always be aimed at creating an umbilicus of sufficient depth and good morphology with less scarring. But such a goal is often difficult to attain. The author's reduction umbilicoplasty is a useful technique in case of abnormal large umbilicus after abdominoplasty. The operation renders better aesthetic result. Technically, the procedure is easy to do and learn. The important steps are the following; the first step is reduction of original umbilicus' circle. The second step is umbilical fixation to the fascia wall using anchoring suture. The third step is cinching suture for decrease "the window" of abdominal flap and this step is more important than other steps. Finally, the suture performed between "the window" and reduced umbilicus. I operated the abdominal large umbilicus using above reduction umbilicoplasty. So, I reviewed that case and discussed the literatures.