QuickScan Reviews in Plastic Surgery, July 15 2009

Background: Patients born with congenital defects of their periumbilical abdominal wall, such as gastroschisis and omphalocele, are left with scars in the center of their abdomen and no umbilicus. Attempts to recreate a neoumbilicus are challenging due to the lack of sufficient local subcutaneous tissue as well as the presence of scar. Objective: To describe a technique that allows for reconstruction of a fairly natural-looking neoumbilicus in children after repair of their congenital abdominal wall defect. Design: Retrospective case review series. Methods: The authors' technique consists of designing caudally based flaps within the abdominal scar left after the abdominal defect repair. The design of these flaps has a "rabbit-head" appearance, as small triangles are included in the vertically oriented flaps that, when inset, minimize contraction of the final result. The flaps are folded downward, incorporating the subcutaneous tissue from the abdomen lateral to the abdominal scar. This additional subcutaneous tissue provides the bulk around the neoumbilicus, contributing to its more natural, depressed appearance. Five patients are described, 2 after gastroschisis repair and the others after omphalocele repair. Four of the 5 patients were female. The average age at operation was 7 years (range, 3 to 14 years). Patient follow-up ranged from 7 months to >5 years. Results: No complications were reported, and satisfactory maintenance of the umbilical shape was achieved. Conclusions: Rotation of caudally based vertical flaps within the abdominal scar that persists after repair of congenital abdominal defects allows successful creation of a neoumbilicus without creating new scars. Reviewer's Comments: This is an interesting technique description that successfully deals with creating an umbilical depression in the center of the patient's scarred abdomen. The clinical cases included had nice results. The authors are correct in that the paucity of subcutaneous fat in these pediatric patients has made recreation of a neoumbilicus, with its associated 3-dimensional contour depression, difficult to achieve in previously described attempts at repair. Elevation of longer portions of the "rabbit-ear" flap beyond what is needed to recreate the neoumbilicus allows for trimming of the flap and avoidance of flap necrosis and contraction of the final result. Unfortunately, use of these flaps is restricted to patients who already have large scar volumes on their abdominal walls. It would not be appropriate to make use of this technique in adult patients who require neoumbilicoplasty. Less than optimal additional visible scarring would be created on the exposed abdominal wall.