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Perforator vessel anatomy of the papilla umbilicalis: topography and importance for reconstructive abdominal wall surgery

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Abstract

Purpose

Separation of midline abdominal wall components or other procedures involving the papilla umbilicalis within the context of abdominal wall reconstruction can significantly affect vasculature of the umbilicus. Adjusting dissection to the vascular anatomy of that region may evade such complications. For this purpose, an anatomic microdissection study was performed, focusing on the vascular architecture of the papilla umbilicalis in the midst of the stratigraphical anatomy of the midline abdominal wall.

Methods

Ramifications of the epigastric vessels were filled with dye on 27 abdominal walls originating from 15 female and 12 male corpses. Vascular architecture of the midline abdominal wall was examined by X-ray imaging and microdissection focusing region of the papilla umbilicalis.

Results

Vasculature of the papilla umbilicalis is provided by both myocutaneous and septocutaneous perforator vessels originating from the medial branch of the arteria epigastrica inferior and accompanying veins. On their way to the inferiolateral basis of the papilla umbilicalis, these perforators prove an intimate and regular association with the rectus abdominis muscle, and different components of the rectus sheath.

Conclusions

Vasculature of the papilla umbilicalis is susceptible to damage resulting from separation of midline abdominal wall components or periumbilical dissections. To secure vasculature of the papilla umbilicalis, the integrity of the loose areolar fascia covering the posterior surface of the rectus abdominis muscle must be kept from being harmed by dissection. In addition, the musculo-fibrous-aponeurotic anatomy on either the left or the right side of the papilla umbilicalis must be left in structural continuity.

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Competing interest statement

The authors declare that they have no competing financial interests.

Authors’ contributions

Study conception and design: Dan mon O’Dey.

Acquisition of data: Dan mon O’Dey, Chukwubikem Akabogu Okafor.

Analysis and/or interpretation of data: Dan mon O’Dey, Chukwubikem Akabogu Okafor, Ahmet Bozkurt, Andreas Prescher, and Norbert Pallua.

Drafting of manuscript: Dan mon O’Dey.

Critical revision of manuscript: Dan mon O’Dey, Chukwubikem Akabogu Okafor, Ahmet Bozkurt, Andreas Prescher, and Norbert Pallua.

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Authors and Affiliations

  1. Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany

    Dan mon O’Dey, Chukwubikem Akabogu Okafor, Ahmet Bozkurt & Norbert Pallua

  2. Department of Surgery, Medical Faculty, RFWU Bonn University, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany

    Chukwubikem Akabogu Okafor

  3. Institute of Anatomy, Medical Faculty, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany

    Andreas Prescher

Authors
  1. Dan mon O’Dey
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  2. Chukwubikem Akabogu Okafor
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  3. Ahmet Bozkurt
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  4. Andreas Prescher
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  5. Norbert Pallua
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Corresponding author

Correspondence to Dan mon O’Dey.

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O’Dey, D.m., Okafor, C.A., Bozkurt, A. et al. Perforator vessel anatomy of the papilla umbilicalis: topography and importance for reconstructive abdominal wall surgery. Langenbecks Arch Surg 395, 1121–1127 (2010). https://doi.org/10.1007/s00423-010-0657-7

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  • DOI: https://doi.org/10.1007/s00423-010-0657-7

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