Neoomphaloplasty with cutaneous graft

Introduction: The umbilical scar is due to the fall of the umbilical stump that occurs a few days after birth. Its presence, shape, and location on the abdominal wall provide the individual with an aesthetic and sensual connotation. Methods: A primary prospective interventional study. The sample was of convenience, from February 2006 to June 2016, and included patients of both sexes attending the outpatient clinic of the Hospital das Clínicas of the Federal University of Pernambuco (HC-UFPE), a private clinic . The inclusion criteria were patients with abdominoplasty indications presenting with compromised circulation to the skin of the umbilical and periumbilical region caused by hernia defects in this area. The study followed the criteria of Helsinki and the patients signed an Informed Consent Form. Results: Twenty-eight patients underwent surgery and good integration of the grafted skin was observed. This resulted in an umbilical scar with a natural appearance and without complications. Conclusions: Neoomphaloplasty with a cutaneous graft is easy to perform and, in the long term, has shown to provide good aesthetic results, especially in thick abdominal flaps, thus proving to be an additional technical option for neoomphaloplasty procedures. ■ ABSTRACT


INTRODUCTION
The umbilical scar is due to the fall of the umbilical stump that occurs a few days after birth.The word navel derives from the Latin, umbilicus, which is the diminutive of umbo.It means rounded protrusion on a surface 1 .Its presence, shape, and location on the abdominal wall give the individual an aesthetic and sensual connotation 2 .
Concern with the aesthetics of the navel during abdominoplasty was first reported in the 1950s by Andrews and Vernon, who reconstructed or transposed it, performing circular incisions in the skin of the abdominal flap [3][4][5] .In Brazil, in 1975, Baroudi introduced a neoomphaloplasty technique that consisted of performing horizontal incisions in the flap while fixing it to the aponeurosis of the rectus abdominis muscle 6 .In 1990, in Japan, Matsuo described the first neoomphaloplasty procedure with a graft, in which he used a conchal cartilage graft 7 .In 2011, Pita et al. 2 described a technique consisting of the association of cutaneous grafts from previously removed umbilical skin with an upper pedicle dermal flap.
In this study, a series of cases are described in which abdominoplasty was performed, associating a new technique known as neoomphaloplasty with a cutaneous graft without the association of the upper pedicle dermal flap.
After defining the new location, a diamond is drawn, approximately 0.5 cm distant from each edge.With scissors, the skin and subcutaneous tissue are then removed.Abdominoplasty is followed by the removal of the excess dermal-fat flap, fixation of the abdominal flap in the aponeurosis with Baroudi points, and suture of diamond edges of the abdominal wall to the graft using nylon 4-0 (Figure 4).Subsequently, the surgical wound is closed in each plane.A suprapubic incision of approximately 30 cm is performed, followed by supra-aponeurotic detachment of the abdominal wall flap from the pubis to the costal edge.Then, a traditional technique of abdominal dermolipectomy was carried out, which proceeded by closing the hernial ring and correcting the diastasis of the abdominal rectus with mononylon 2-0.Then, the new location of the umbilical scar was defined, which usually corresponds to the region of the intersection of the midline of the abdomen with a horizontal line connecting the anterior superior left iliac spine to the right, which is also marked with bright green.
The remaining skin of the umbilical scar is then perforated with a blade No 15 to facilitate the integration (handle) fixed in the region previously marked in the aponeurosis of the rectus abdominal muscles with 4-0 monocryl (Figure 3).Then, the new location of the umbilical scar is defined on the skin of the abdominal flap,

RESULTS
Twenty-eight patients underwent the surgery.A good integration of the grafted skin was observed, which resulted in an umbilical scar of natural appearance and without complications (Figure 5).

DISCUSSION
The first reports of umbilical reconstruction date back to the 1950s, with descriptions by Andrews and Vernon reconstructing or carrying out their transposition, and performing circular incisions on the skin of the abdominal flap [3][4][5] .
The use of grafts in performing neoomphaloplasty was first reported by Matsuo in 1990 in Japan, although this was a conchal cartilage graft 7 .Subsequently, in Brazil, in 2011, Pita et al. 2 described a technique consisting of the association of cutaneous grafts, from the umbilical skin previously removed, with a dermal flap of the upper pedicle.However, the authors modified the technique, eliminating the necessity of the dermal flap, with improvements in the final aesthetic result.
This neoomphaloplasty technique is easy to perform and can provide satisfactory aesthetic results.One of the reasons for its natural appearance is the use of local tissue as the graft donor area, applying one of the fundamental principles of reconstruction, namely the "like with like," which in Portuguese is "de igual para igual" 8 .

CONCLUSION
Neoomphaloplasty with a cutaneous graft is easy to perform and in the long term has shown to provide good aesthetic results, especially in thick abdominal flaps, demonstrating it is an option in performing neoomphaloplasty procedures.

Pita
PCC et al. www.rbcp.org.br the skin, this measures approximately 1.5 cm in diameter and corresponds to the pre-existing umbilical scar in the abdominal flap.With a scalpel blade No. 15, the skin is resected with partial dermal thickness (Figure 2) and placed in a tank with saline solution for subsequent grafting.