Umbilicoplasty in Neonates with a New Technique: Results of 20-Year Follow-Up

Abstract

Context:

An aesthetically acceptable umbilicus is an important component of the body and absent or dysmorphia may lead to psychological discomfort. Therefore reconstruction of neoumbilicus attains importance in abdominal surgical planning. This innovative surgical creation of umbilicus was planned during the initial surgery of umbilical defects to achieve these goals with minimal scarring.

Materials and Methods:

Our technique was applied to all 26 cases: primary omphalocele repair (n = 5), abdominal wall reconstructions after conservative management of large omphaloceles (n = 17), large umbilical hernias (n = 3), and one case of patent vitelointestinal duct with redundant skin. All patients were followed up yearly for the aesthetic appearance and clinical photographs were recorded.

Results:

Technique applied to all 26 patients had excellent cosmesis and long term follow up was very encouraging.

Conclusions:

All patients had successful abdominal wall closure. Most of the patients had minimal scar of the large hernia repair and the umbilicus was normal looking and well accepted cosmetically.

INTRODUCTION

Advances in pediatric surgical techniques and improvement in the neonatal nursing care over last 25–30 years have improved outcomes and the survival of newborns with omphaloceles. While the adolescent and adult survivors develop self-image, an esthetically acceptable umbilicus with minimal scarring is an important component of the body which can avoid psychological problems.[1,2,3,4,5,6] The absence or dysmorphia of the umbilicus may give rise to psychological discomfort, making it a common concern in surgical planning.[2] Many techniques of umbilicus reconstruction have been proposed, each with its own limitations in terms of esthetics, risk of stenosis, or final positioning and associated scarring.[2,3,4,5,6,7] Reconstruction techniques may involve skin grafting, cartilage, purse-string suture, and flaps. One of the most promising approaches is scarless neo-umbilicoplasty.

A new technique of umbilicoplasty is described with technical details. The result has encouraged us to publish this apparently simple technique.

TECHNIQUE

Our technique was applied to all 26 cases: primary omphalocele repair (n = 5), abdominal wall reconstructions after conservative management of large omphaloceles (n = 17), large umbilical hernias (n = 3), and one case of patent vitelo-intestinal duct with redundant skin. All patients were followed up yearly for the esthetic appearance and clinical photographs were recorded. Anatomical closure of large ventral hernias of omphaloceles was repaired by previously described technique.[1] After closure of the defect in the sheath, the flaps were raised and the incisions were marked as shown in Figure 1a and b. Basically, the procedure applies principles of Z-plasty with inversion of the cone achieved by suturing point A and B as seen in Figure 1c. Tugging it to the midline aponeurosis at the site of normal umbilicus, an umbilication is achieved as shown in Figure 1d. Our technique is illustrated in Figures 2 and 3. Deposition of fat in the surrounding tissue gave adequate depth and acceptable normal appearance. Omphalocele minor is depicted for representative purposes. Similar incisions were marked at the caudal end of the redundant flaps after closing the rectus sheath in ventral hernia and secondary repair of omphaloceles.

Figure 1.

(a) Marking of incision on the flap after omphalocele repair as seen from right side. Suturing point marked as A. (b) Incision marked on the left side. Suturing point marked as B. (c) Point A and B sutured to give a cone of skin flaps. (d) Cone of skin inverted and suture to the sheath in the midline. Rest of the incision closed and the forceps end inserted in neo-umbilicus for demonstration

Figure 2.

A case of omphalocele minor selected for illustration purpose; (a) preoperative, (b) after repair of the defect in the sheath, (c) marking of flap on the right side, (d) marking of flap on the left side, (e) creation of the cone of skin, (f) inversion of cone and suturing to the sheath, (g) completed repair

Figure 3.

After closure of the remaining part of skin, (a) immediate postoperative view, (b) follow-up after 8 days, (c) follow-up after 20 years

RESULTS

All patients had successful abdominal wall closure. Most of the patients had minimal scar of the large hernia repair and the umbilicus was normal looking and well accepted cosmetically.

A number of techniques of reconstruction of umbilicus have been described previously.[2,3,4,5,6,7,8] A few reports have 1–2-year follow-up of the cosmesis of the esthetically important part of the abdomen. Literature is devoid of long-term results up to adolescence. The salient advantage of this technique is that the flaps were designed at the time of primary surgery without extending the incision beyond the base or on either side of the midline. Even in large ventral hernia or secondary repair of omphaloceles, the closure of the incision superior to the neo-umbilicus was in the midline giving a cosmetically accepted appearance. We have not applied this technique in primary repair of exstrophy of bladder for creation of neo-umbilicus as the defect was low and adequate flaps were not available for creation of cone for inversion and placement in the normal place. Closure of the abdominal wall defect with simultaneous umbilicoplasty provided excellent results in the present series with 20-year follow-up.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.