Indications, outcomes, and complications of neoumbilical reconstruction: A systematic review.

BACKGROUND AND OBJECTIVES: Neoumbilicoplasty aims to reconstruct an aesthetically pleasing new umbilicus following agenesis, malignancy, anatomical distortion, or umbilicus loss. Despite the wide variety of surgical techniques described, literature is scarce when it comes to standardized categorization of these as well as the clear definition of patients' selections, specific indications, final outcomes, and possible complications. According to available literature, this work aims to evaluate different surgical approaches, and correlate them to specific surgical needs, to simplify the surgical choice and patient management. METHODS: A systematic review was performed in December 2020 in PubMed, Web of Science, and MedLine Ovid databases according to the PRISMA guidelines. RESULTS: A total of 41 studies and 588 patients were finally included. On the basis of the evidence of the literature collected, we divided the studies into four groups according to the neoumbilicoplasty techniques: single suture or purse-string suture, single flap, multiple flap, and skin graft. Patients' surgical comorbidities, neoumbilicoplasty indications, and aesthetic and surgical outcomes were investigated. Direct suture and single and multiple flap techniques assured overall, satisfactory cosmetic outcomes with a low rate of surgical complications. Whereas suture-only techniques were chosen mostly by general surgeons/urologists in laparoscopic surgery, the single flap was the preferred method to reconstruct the umbilicus in open abdominal surgery or combined abdominoplasty with herniorrhaphy. Multiple flap and skin grafts were adopted in abdominoplasty-related umbilicus reconstruction, although the latter option showed impactful aesthetic and surgical complications. CONCLUSIONS: Umbilicoplasty can assure generally pleasant aesthetic outcomes with relatively low complication rates. Indications for specific techniques correspond to different patient populations and surgical scenarios.

A Case of Primary Endometriosis Associated With an Umbilical Hernia.

Endometriosis is a common gynecological disease that mainly influences pelvic organs. However, extra-pelvic endometriosis is considered less prevalent. Here, we present a case study of umbilical endometriosis associated with an underlying hernia. It is known that the incidence of such a case is very rare and its diagnosis is challenging. Surgical excision of this type of lesion with a repair of the hernia is considered the preferred management approach. In this case, a 40-year-old female was admitted to the hospital with cyclical umbilical bleeding for one year. The bleeding would start with her menstruation and continue throughout the menstrual period. Initial diagnosis was made by physical examination and ultrasound imaging. Treatment options were discussed with her and she accepted to undergo surgical wide excision of the umbilical lesion with a repair of the hernia. Diagnosis was further confirmed by a histopathological study of the lesion tissue specimen. Also, a referral to a gynecologist did not report any abnormality or pelvic disease, and the patient was discharged well from the hospital.

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.

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 simple technique for neoumbilical reconstruction for congenital hernia associated proboscis deformity.

INTRODUCTION: Umbilical reconstruction in pediatric patients who have developed a large proboscoid redundancy can be challenging after standard umbilical repair. We present a simple and unique surgical technique that results in a cosmetically appealing reconstruction. OPERATIVE TECHNIQUE: The operation is initiated with circumferential redundant skin excision and isolation of the hernia sac. Primary fascial repair is performed. Reconstruction utilizes the cut dermal/epidermal edge by approximating it to the exposed fascia just below the skin edge outside of the fascial repair in a purse string fashion for the creation of a neoumbilicus. CONCLUSION: This simple technique is unique from any currently published methods and results in a cosmetically pleasing reconstruction without evidence of any incision. LEVEL OF EVIDENCE: Level V: Expert Opinion.

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.

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.

Positioning the Umbilicus in African Newborns with Large Anterior Abdominal Wall Defects.

OBJECTIVE: We tried to determine the normal position of the umbilicus in African newborns with a potential application in aesthetically acceptable umbilical reconstruction. SUBJECTS AND METHODS: The study involves a cross-sectional study of 896 healthy neonates who underwent clinical abdominal examination and measurement of the distances between the xiphoid process and the umbilicus (XU), xiphoid process and the pubis (XP), umbilicus and the pubis (UP), umbilicus and the anterior superior iliac spine (UASIS), abdominal girth (AG), and inter anterior superior iliac spines (IASIS) distance. The gestational age at delivery, age at measurement, sex, AG measured across the umbilicus, birth weight (BW), body length, and body mass index of the newborns were recorded. The measurements were used to determine the location of the umbilicus and Pearson's correlation analysis performed to determine the relationships of the recorded neonatal parameters with the measurements. RESULTS: The mean XP was 11.97 ± 2.09 cm, XU = 7.94 ± 2.74 cm, UP = 4.26 ± 1.21 cm, UASIS = 5.79 ± 1.04 cm, and IASIS = 10.25 ± 1.54 cm. The BW, length, and AG significantly correlated with the distance between the XU, umbilicus and pubis, umbilicus and anterior superior iliac spine as well as the distance between the two anterior superior iliac spines. CONCLUSION: The position of the umbilicus is dependent on the selected participants' characteristics. We suggest that a UP: XU ratio of 0.55 should be used to position the umbilicus during umbilical reconstruction in African neonates.

Umbilical necrosis rates after abdominal-based microsurgical breast reconstruction.

BACKGROUND: Umbilical stalk necrosis represents a rare, yet important complication after abdominal-based microsurgical breast reconstruction, which is both underrecognized and understudied in the literature. Once identified, umbilical reconstruction can be an extremely challenging problem. METHODS: All consecutive breast free flaps at a single institution from February 2004 to February 2016 were reviewed, excluding non-abdominal-based flaps. Patients were divided based on the development of umbilical necrosis postoperatively. Demographics, surgical characteristics, and other complications were compared between the groups. RESULTS: A total of 918 patients met the inclusion criteria, with 29 developing umbilical necrosis identified (3.2%). Patients developing necrosis tended to be older (49.4 yrs versus 52.9 yrs; P < 0.01); have higher BMI (31.3 versus 27.8; P < 0.01); and were more likely to be smokers (27.5% versus 11.6%; P = 0.01). Umbilical necrosis was also associated with increased flap weight (830 g versus 656 g; P < 0.01), decreased time of perforator dissection (151 min versus 169 min; P = 0.02); bilateral cases (68.9% versus 44.7%; P < 0.01), and increased number of perforators per flap (2.5 versus 2.2; P = 0.03). There was no association with flap type (deep inferior epigastric perforator, superficial inferior epigastric artery, or free TRAM), diabetes, previous abdominal surgery, or use of preoperative imaging. Umbilical necrosis was not associated with any concomitant complications. CONCLUSIONS: Umbilical stalk necrosis was found to occur in 3.2% of patients and was associated with several preoperative comorbidities and intraoperative characteristics. This information should help influence intraoperative decision-making to prevent the development of this undesirable complication.

Spontaneous endometriosis associated with an umbilical hernia: A case report and review of the literature.

INTRODUCTION: Umbilical endometriosis occurring in the presence of an underlying hernia is extremely rare and presents a diagnostic challenge for the general surgeon. We present an interesting case and perform a comprehensive review of the literature. METHODS: Medline and PubMed were queried for all cases of spontaneous umbilical endometriosis associated with an umbilical hernia. Data was analyzed and is presented along with an interesting case. RESULTS: Only 7 cases have been reported in the literature. Median age was 38 years. Time to presentation was long (up to 5 years) and the majority had cyclical symptoms related to menstruation. All patients, including our case, were treated surgically. DISCUSSION: Spontaneous umbilical endometriosis with an underlying hernia is often missed preoperatively. Preoperative suspicion warrants axial imaging for better operative planning and patient counseling. Surgery consists of enbloc excision of the umbilicus, implant and the hernia sac to avoid residual disease and reduce recurrence. The hernia defect can be repaired primarily or using mesh and the umbilicus reconstructed using skin flaps if necessary. CONCLUSIONS: Surgery is the mainstay of therapy for umbilical endometriosis associated with an underlying hernia. Clinical suspicion warrants preoperative imaging, and follow-up with a gynecologist is essential to address any pelvic disease.

Modified method for umbilical reconstruction after single-incision laparoscopic surgery / 中国现代普通外科进展

Objective:To introduce a modified method for umbilical reconstruction after single-incision laparoscopic surgery.Methods:Between June 2012 and June 2015,173 patients underwent single-incision laparoscopic cholecystectomy at our institution.All the patients adopted our modified method for umbilical reconstruction.Results:All the surgeries were successful.The umbilical incision healed well with good cosmetic result.Conclusion:The modified method for umbilical reconstruction can improve cosmesis and decrease the possibility of incision hernia after single-incision laparoscopic surgery.More studies are needed to evaluate definitive clinical advantages of this technique.

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.

Reconstruction of Scarred Umbilicus Using an Inverted C-V Flap: A Case Report

PURPOSE: The umbilicus is an important aesthetic component of the abdomen. Its absence is both cosmetically and psychologically distressing to the patient. Umbilical reconstruction should always be aimed at creating an umbilicus of sufficient depth and good morphology with less scarring. The C-V flap developed for nipple reconstruction was used in an inverted fashion in case of umbilical reconstruction. The aim of this article is to report our experience of scarred umbilical reconstruction using inverted C-V flap. METHODS: A 22-year-old woman presented with contracted scar tissue in the umbilical region because she had undergone surgical correction of an umbilical hernia at 5 year of age. Pedicle of the inverted C-V flap was based cephalically. For enhancing depth of the umbilicus, three anchoring sutures to linea alba were done at both lateral and caudal aspects of the umbilical tube. Primary closures were done at donor sites of the V flaps and bolster sutures were done in the caudal direction of the inverted umbilical tube. RESULTS: The patient was satisfied with the appearance of umbilicus. Major complications such as dehiscence, infection, and delayed healing did not occur. CONCLUSION: The inverted C-V flap is easy and simple technique, and it can produce a satisfactory reconstruction of umbilical structure.

A Case of Immediate Umbilical Reconstruction after Surgical Excision of Keloid / 대한피부과학회지

The umbilicus is an important aesthetic component of the abdomen. Surgical procedures for omphalocele, gastroschisis, urachal cyst, and various benign or malignant tumors of the umbilical area can result in the absence of the umbilicus. Loss of the umbilicus can be an embarrassing deformity, and several methods have been used to reconstruct umbilicus, with mixed results. A 66-year-old male presented with a large mass measuring 4 x 4 cm on his umbilicus. The mass, histopathologically confirmed as keloid, developed after moxa cautery 13 years ago. Complete surgical excision resulted in a large defect, and immediate umbilical reconstruction with purse-string suture technique was done. The patient was seen at follow-up 6 months later, and the umbilicus had a satisfactory appearance.

Immediate Umbilical Reconstruction after Removal of Umbilicus due to Urachal Cancer: Defatting, Anchoring and Purse-String Suture

Reconstruction of the umbilicus is not a frequent event. Umbilical restoring should always be aimed at creating an umbilicus of sufficient depth and good morphology(circular and cylinder shape) with less scarring. A wide range of techniques has been described to reconstruct neoumbilicus; nevertheless, a perfect result is difficult to obtain. I provide another alternative to reconstruct the umbilicus using defatting, anchoring and purse-string suture. The important steps are the following; the first step is defatting of 2.0cm umbilicus' circle. The second step is to umbilical fixation to the fascia wall using anchoring suture. The third step is purse-string suture to decrease new formative umbilicus and to make the circular and cylinder shape umbilicus. The author's method is a simple, easy and useful technique and renders better aesthetic result. So, I reviewed two cases and discussed the literatures.

Immediate Umbilical Reconstruction for Urachal Cancer

The umbilicus is a central line of abdomen and can be an important aesthetic interest in the abdomen wall, so its loss can be a source of psychological distress. Many techniques for reconstruction of a lost umbilicus have been described, however none has achieved a perfect result. There are few reports that describe the procedure for immediate reconstruction of umbilicus after surgical ablation except Miller's Iris technique. We have performed umbilical reconstruction right after the umbilicus was resected during the surgery. The patient was a 34 year old man with urachal cancer, who wanted to have his lost umbilicus reconstructed immediately for personal, social, and aesthetic reasons. We tried immediate reconstruction with modified iris technique. Using three local flaps, we fixed the central portion of inferior flap at the area of 1 cm below umbilical defect on linea alba. The neoumbilicus retained in its depth and natural shape. This technique is considered to be simple and draw good results.