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PubMed2006

Reconstruction of a natural-appearing umbilicus using an island flap: case report.

A case of successful reconstruction of the umbilicus using a depressed scar in an 11-year-old girl with a large and rigid scar spreading around the centre of the abdominal wall is presented. The anatomical umbilicus was replaced by a large scar after a previous surgery for umbilical cord hernia. The difficulty of the conventional method compelled us to use a distant scar dimple as an island flap. In addition, the three-dimensional morphology of the umbilicus could be reproduced by rolling a spindle island flap into a cone. Postoperatively, the reconstructed umbilicus has remained deep and aesthetically well shaped.

Child↗
PubMed2002

Reconstruction of a natural-looking umbilicus.

Based on the assumption that the umbilicus is a wound that has healed by second intention, we describe a method of reconstruction. The procedure consists of complete resection of the umbilical scar and its reconstruction by a linear incision at the site of the new umbilicus and inversion of the skin hedges, which are sutured to the linea alba leaving a 1 cm space between the skin borders to cause secondary wound healing. This procedure provides a natural-looking umbilicus. It is easy and quick to do, and can be used for reconstruction after abdominoplasty, excision of a naevus, or when the umbilicus has been removed during a previous xiphopubic incision.

Adult↗
PubMed2004

An anatomical method for re-siting the umbilicus.

The umbilicus is the only normal scar on the body and it is the most noticeable scar following abdominoplasty and TRAM or DIEP flap procedures. We describe a technique for resiting the umbilicus that attempts to recreate the anatomical structure by attaching the superficial fascia to the periumbilical skin to produce a fullness around the depression in which the umbilicus sits. This is aesthetically desirable and avoids the uncomfortable tethering of the umbilicus to the rectus sheath associated with other techniques.

Cosmetic Techniques↗
PubMed1976

Pilonidal sinus of the umbilicus.

Only 15 cases of pilonidal sinus of the umbilicus have so far been reported. A 16th case is described; it supports the theory of acquired origin of the disease. The case fulfilled the criterion for pilonidal sinus--the 36-year-old man had a hair in the infected umbilical cyst. The cyst and umbilicus were excised. The umbilicus was not reconstructed because of the danger of recurrence. It is recommended that a careful search be carried out for hair in all patients with an infected umbilicus.

Adult↗
PubMed2004

Autosomal dominant flat umbilicus.

We describe a Chinese family among whom five members in three generations had a flat umbilicus with vertical and male to male transmission indicative of autosomal dominant inheritance. Except the proband, who also had Tetralogy of Fallot, other affected members had a flat umbilicus as an isolated anomaly. Autosomal dominant transmission of isolated flat umbilicus has not been reported previously.

Adolescent↗
PubMed1997

Urine leakage from the umbilicus in a child with achondroplasia and tetraplegia (due to cervical stenosis): a safety vent for the obstructed neuropathic bladder.

Urine leakage from the umbilicus was observed while expressing urine by the Crede manoeuvre in a three-year-old tetraplegic girl with a chronically distended urinary bladder. Intravenous urography (IVU) revealed bilateral hydroureteronephrosis with markedly distended urinary bladder. Regular three hourly intermittent catheterization was advised, and the parents and carers of this child agreed to perform catheterization. There was cessation of urine leak within 48 hours of urethral drainage. Cystography performed two weeks later showed no vesicoureteric reflux; vesicoumbilical fistula was no longer demonstrable. Follow-up IVU, performed after eight and half months of regular intermittent catheterization, showed regression of hydroureteronephrosis. We believe that urine leakage from the umbilicus served two important protective functions in this child, viz. (1) it prevented possible vesical or renal rupture; (2) the striking clinical symptom of urine leak from the umbilicus focussed the attention of the carers to the underlying serious condition of the urinary tract. Further, this case demonstrates that regression of marked hydroureteronephrosis can be achieved by intermittent catheterization performed at regular intervals by devoted parents/carers, in selected cases of spinal cord injury with neuropathic bladder, and vesical outlet obstruction, thus obviating the need for any form of temporary or permanent urinary diversion.

Achondroplasia↗
PubMed2004

Umbilicoplasty for large protruding umbilicus accompanying umbilical hernia: a simple and effective technique.

A large umbilical protrusion with redundant skin accompanying an umbilical hernia sometimes needs umbilicoplasty. Although several different techniques for making umbilical depression have been used, the results of the plastic surgery are sometimes unsatisfactory due to postoperative flattening or disappearance of the umbilical depression. To make a permanent umbilical depression that is cosmetically acceptable, we have modified the techniques. Umbilicoplasty was performed in 14 children whose ages ranged from 6 months-6 years and 3 months (median, 1 year and 10 months) and who had umbilical hernia with a large umbilical protrusion. After the fascial defect was closed, the diameter of the umbilicus was reduced to half that before surgery by removing fan-shaped skin flaps and approximating skin edges, and then inverting the umbilicus and fixing it caudally to the fascia and skin. There were no postoperative complications, and no flattening or disappearance of umbilical depression was observed during the follow-up of 10-19 months. The authors' technique of umbilicoplasty for a large protruding umbilicus accompanying umbilical hernia is a simple method that produces acceptable cosmetic results.

Child↗
PubMed1988

Unusual presentation of patent vitello intestinal duct with round worms emerging from the umbilicus.

Patient vitello intestinal duct (VID) is not an uncommon anomaly in children. It usually presents with fecal discharge from the umbilicus. Round worm infestation is very common in Indian children, but an association of patent VID and ascariasis, presenting as round worms emerging from the umbilicus, is unique and has not been previously reported in the literature. We present such a case in a 2-year-old boy who presented with a history of round worms coming out through the umbilicus. It was provisionally diagnosed to be a case of patent VID, which was proven correct on laparotomy.

Ascariasis↗
PubMed2001

The normal position of the umbilicus in the newborn: an aid to improving the cosmetic result in exomphalos major.

BACKGROUND/PURPOSE: The aim of this study was to determine the normal position of the umbilicus and hence improve the cosmetic result of exomphalos major repair. METHODS: The position of the umbilicus was determined in 50 neonates with respect to the xiphisternum and pubis. RESULTS: The normal umbilical position is 60% of the way from the inferior border of the xiphisternum to the superior border of the pubis in the midline. CONCLUSION: In the repair of exomphalos major, the most aesthetically pleasing result is obtained if the umbilicus is placed 60% of the way from the xiphisternum to the pubis.

Esthetics↗
PubMed1995

Reconstruction of the umbilicus using a single triangular flap.

Many techniques for reconstruction of an absent umbilicus have been described; however, none has achieved a perfect result. We report a new alternative for constructing an umbilicus using a conical flap and present two representative clinical cases. Our technique creates an umbilicus with sufficient depth with good results, including maintenance of depth after more than 1 year.

Humans↗
PubMed2002

Superior positioning of the ptotic umbilicus in abdominoplasties and TRAM flaps.

The author finds that higher positioning of the umbilicus in cases of abdominoplasty and other similar operations such as transverse rectus abdominis musculocutaneous flap breast reconstruction is a useful technique. The operation renders better aesthetic results and also increases the margin of safety in lower abdominal flap circulation because tension is transferred from the lower abdomen to the upper abdomen. Technically, the procedure is easy to do and teach. The umbilicus is fixed to a higher point in the abdominal wall and the new umbilicus is reconstructed in a reasonably higher position with a safe degree of tension at the upper abdominal flap while trying to decrease tension in the lower part of the abdominal flap.

Abdominal Muscles↗
PubMed1978

Placement of the umbilicus in an abdominoplasty.

The location of the umbilicus was measured in 100 randomly selected non-obese subjects. It was found that a line drawn from the highest level of the crest of one ilium to the same point on the other side will transect the umbilicus in 96 percent of the subjects. This relationship can be of use during an abdominoplasty, when determining the location for the umbilicus.

Abdomen↗
PubMed2002

Discharging umbilicus.

OBJECTIVE: Umbilical discharge is a symptom of varied pathology. Treatment policies of this clinical problem vary among different institutions. Our experience in the management of 44 patients with umbilical discharge is presented. METHODS: This is a retrospective study of the 44 patients treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia over a period of 19 years from 1982 to 2001. RESULTS: With the exception of one patient, all patients were treated in the outpatient clinic. General anesthesia was not employed but instead local anesthesia was used in some cases. One patient required admission for surgical excision, diagnosed to have an ulcerating dermoid cyst. Most patients had hair tuft in the infected umbilicus (pilonidal sinus of umbilicus), 2 patients had concrete like material inside the infected umbilicus. CONCLUSION: We propose a conservative approach to treat this problem and preserve surgical excision only for selected cases.

Adult↗
PubMed2003

[Bleeding caused by the trocar insertion through the umbilicus as a rare complication of laparoscopy].

The report of case in which bleeding from the anterior abdominal wall vessels occurred after the trocar insertion through the umbilicus. Directly after trocar removing there was insignificant bleeding from the trocar incision. Despite initial hemostasis with a suture ligation a postoperative blood loss and peritonitis syndrome necessitated transfusion and diagnostic laparoscopy. No vessel injury was localised during the subsequent laparoscopy. The bleeding originated from the trocar incision--a small artery was injured. The hemostasis suture was fastened. The reported case is a unique example of a laparoscopic complication. The umbilicus seemed to be a very safe localisation for the first trocar insertion--there are no reports of appearance of abdominal vessels within the umbilicus. Besides the suture ligation usually ensures an effective hemostasis--the diagnostic laparoscopy or laparotomy is are performed in exceptional situations.

Abdominal Wall↗
PubMed1993

Familial hydrocephalus with a low-insertion umbilicus.

Two brothers, age 16 months and 3 years, had a seemingly unique combination of hydrocephalus of the lateral ventricles and a low-insertion umbilicus. Both had similar mildly unusual facies and inguinal hernias; one had unilateral cryptorchidism. The older brother had tetralogy of Fallot, and the younger had mildly enlarged, echogenic kidneys with vesicoureteral reflux. Neither boy had adducted thumbs, pyramidal tract signs, or significant developmental delay. A review of the literature on familial hydrocephalus found no similar cases. A low-set umbilicus is not a frequently noted anomaly; its embryology and associated syndromes are discussed. The association of hydrocephalus and a low-set umbilicus appears to be the manifestation of a monogenic disorder in this family, and could be inherited in either an autosomal recessive or X-linked recessive manner.

Child, Preschool↗
PubMed2003

Reconstruction of the umbilicus using a reverse fan-shaped flap.

The goal of the reconstruction for umbilical absence is to obtain a natural three-dimensional appearance of the umbilicus with minimal operative scarring. This paper presents two cases of umbilical reconstruction using a reverse fan-shaped flap. In both cases, the umbilicus was lost during surgical procedures on the abdominal wall when the patients were newborns. We performed this technique in both cases. This technique is simple and safe. With this technique, a permanent umbilical depth and ring can be obtained without any complications.

Child, Preschool↗
PubMed2005

Umbilicus reconstruction with modified 'unfolded cylinder' technique.

Many techniques have previously been reported for reconstruction of the umbilicus. The common goal of reconstruction is to obtain a stable and aesthetically pleasing umbilicus with sufficient depth. Presented here is the reverse application of an 'unfolded cylinder' design, which has previously been reported for nipple reconstruction. The procedure can be applied with local anaesthesia on an outpatient basis and the drawing of the design is simple. Since the walls of the neoumbilicus are consisted of flaps, which are brought together without any twisting or tension, long-term use of a stent is unnecessary and the result is mostly stable and lasting. Moreover, the depth of the neoumbilicus is adjustable by widening the top rectangle in its design, which can increase it. Therefore, the procedure is suitable for thin as far patients.

Ambulatory Surgical Procedures↗