Dermal Shift Umbilical Reconstruction: An Innovative and Simple Technique

Abstract

Summary: Umbilical reconstruction is a procedure with widespread indications in the setting of congenital or postsurgical loss. Reconstruction of the umbilicus when no remnant of the natural umbilicus is present is also called neoumbilicoplasty. Numerous neoumbilicoplasty techniques have been published, including cartilage grafts, full-thickness skin grafts, and multiflap reconstruction. No consensus has been reached regarding an optimal technique, and many procedures involve complicated designs with small flaps that are difficult to reproduce or explain. The authors divide patients into three types depending on the thickness of the adipose layer of the abdomen. With appropriate patient selection and minor variations depending on patient type, the technique can be applied to all patients. The umbilicus is marked in the appropriate position. Local anesthesia is infiltrated, and the area beneath the skin is defatted. The dermis is then applied to the underlying fascia with a superior shift. The authors describe the technique and its variations and present one illustrative case with additional supplemental digital content. The authors have gone through a progression of techniques to find a simple surgical method yielding consistently reproducible results with minimal complexity, limited morbidity, and an aesthetic final outcome. The authors believe that the technique described here achieves those goals. It can be performed under local anesthetic and with a simple occlusive dressing so that the patient can go on with most of his or her daily activities. There is no scar to suggest a surgical procedure, and patients are extremely happy with the aesthetic outcomes.

The Scarless Neo-Umbilicus in DIEP-Flap Breast Reconstruction

“…With the consecutive application of this new technique in DIEP patients a learning curve could be observed. In the beginning, the vertical skin incision described in the work of Yousif et al [ 9 ] was executed, but later omitted as access from the inside was always given in our patient collective. The bolster bandage that was applied in the original work and that was fixated via a tie-over suture was omitted as well, as the compression pants can equally fulfill the purpose, and the risk of infection is then reduced.…”

“…A total of 30 consecutive breast cancer patients were treated during a period of 10 months with a mastectomy and an immediate reconstruction with a DIEP-flap. All patients underwent immediate reconstruction of the umbilicus by a neo-umbilicoplasty technique that was described by Yousif et al [ 9 ]. In the first 4 patients, we performed transcutaneous stitches and made a short incision in the center of the neo-umbilicus to ensure very stable mattress sutures.…”

“… Results after neo-umbilicoplasty. ( a ) In the beginning, the technique of Yousif [ 9 ] was used. The transcutaneous stitches can cause visible scarring.…”

“…This led us to adopt a new technique of umbilicoplasty by removing the umbilicus and creating a new umbilicus from the abdominal wall. In the beginning, we followed the technique of Youssif which creates a central incision and uses four transcutaneous stitches [ 9 ]. We then abandoned the transcutaneous stitches/incision and switched to a buried fixation purely from the inside as described below.…”