Managing the umbilicus during abdominoplasty

The inverted-v chevron umbilicoplasty for breast reconstruction and abdominoplasty

The umbilicoplasty is a key component of abdominoplasty and closure of autologous abdominal wall donor sites in breast reconstruction (TRAM/DIEP). The aesthetically-pleasing umbilicus tends to be small and vertically-oriented in nature, with superior hooding and shadow, inferior retraction and slope, and positioning at the topmost level of the iliac crest. In this Featured Operative Technique, the authors describe their technique for performing an inverted-V chevron umbilicoplasty, which is their method of choice for restoring the umbilicus to an aesthetic and youthful appearance with minimal scarring.

Submandibular neck lifting with platysma resection

A novel method for cervicofacial rejuvenation by submandibular neck lifting with platysma resection is presented. Between 2003 and 2009 we performed submandibular neck lifting in 18 cases. This technique is an isolated but efficient procedure for lifting of the neck. An additional advantage might be the possibility of doing the procedure with tumescence local anesthesia. In all cases, satisfactory aesthetic results were achieved.

Umbilical reinsertion in abdominoplasty: technique using deepithelialized skin flaps

One goal of abdominoplasty is to reestablish a natural-appearing umbilicus with hidden scars. The authors present a new technique for navel reinsertion.

The arterial vascularisation of the abdominal wall with special regard to the umbilicus

AIM

In order to prevent wound healing problems around the transposed umbilicus following abdominoplasty, we investigated the arterial vascularisation of the abdominal wall with special regard to the umbilicus. The aim was to optimise the planning of the umbilical stalk and flap design.

METHOD

The inferior and superior epigastric arteries of 12 cadavers (mean age 83 years) were injected with barium-sulphate, lead-mennige and gelatine. The abdominal walls were resected en bloc and X-ray photographs were taken by conventional and mammographic technique.

RESULTS

The radiographic examination showed that the main trunks of the epigastric vessels follow an "hour-glass" or "rhomboid" pattern around the centromedial umbilicus. Each main trunk splits into two obligate branches one medial and one lateral. The anastomosis between the inferior and superior epigastric artery is located above the umbilicus. The umbilicus is nourished by separate axial vessels originating from the inferior epigastric artery. It was also shown that the inferior intercostal arteries anastomose with the branches of the inferior and superior epigastric artery.

CONCLUSION

Dividing the abdominal wall into four quadrants around the central umbilicus, the lateral areas of the lower quadrants show the weakest vascularisation by the inferior epigastric artery. This fact may cause healing problems after surgery in this area. The axial vascularisation of the umbilicus makes any torsion or traction a potential hazard to the umbilical flap during abdominoplasty especially by re-siting the umbilicus. The anatomical study showed clearly the benefit of preparing a broad base fat layer with a generous diameter of incision line around the umbilicus.

Simplified technique for creating a youthful umbilicus in abdominoplasty

Reimplantation of the umbilicus remains a critical aesthetic component in abdominoplasty and transverse rectus abdominis musculocutaneous breast reconstruction. Although the ideal shape of the umbilicus has been debated, recent studies have shown the young, thin female with an attractive abdomen tends to have a small, vertically oriented umbilicus. The aesthetic considerations for reimplantation include position, depth, shape, and location of scar. The authors present a technique that is expedient and reliable and that addresses each of these variables. The umbilicus is sutured to the rectus fascia and reimplanted through a vertical incision in the abdominal flap. Subdermal sutures are placed from the umbilicus to the linea alba superiorly and inferiorly. These sutures create a vertically oriented shape and place the umbilicus in the midline. Shortening the umbilical stalk establishes depth and hides the closure of the umbilicus and abdominal flap within the stalk. The stalk length is easily varied, depending on the thickness of the panniculus. Defatting is performed through the vertical incision to allow easy visualization of the umbilicus. This technique creates depth, ensures optimal position, pulls the scar deep in the umbilicus, and produces a vertically oriented, youthful umbilicus. More importantly, a questionnaire given to patients who have undergone abdominoplasty with this procedure (n = 21) confirms that patients have a high level of satisfaction with the resulting shape, position, and overall appearance.

Umbilical transposition in TRAM flap: a simple horizontal translocation

A simple method of umbilical repositioning by incising the anterior rectus sheath and rectus abdominis muscle is reported for cases of unilateral abdominal wall plication during the TRAM flap operation. This method keeps the umbilicus stable and nonstenotic, and it avoids hypertrophic scars, which result from other techniques such as direct suturing of the stalk to the skin. Although this method might weaken contralateral muscle activity, the patients we operated on maintained their ability to perform sit-ups, and no periumbilical weakening was noticed.

New technique for scarless umbilical reinsertion in abdominoplasty procedures

The most visible scar in the conventional abdominoplasty procedure or TRAM flap donor site closure is the scar around the reinserted umbilicus. In an attempt to increase the aesthetic outcome, the authors have introduced a new technique of umbilical reconstruction and reinsertion during abdominoplasty avoiding any paraumbilical scar, which results in a more natural appearance in that area. This new technique, potential pitfalls, and long-term results are reported.