Ideas and Innovations Reconstruction of the Umbilicus in Abdominoplasty . José Ju Buenos Aires, Argentina One of the problems in abdominoplasty has been the appearance of the navel after healing is complete. We have developed an operative tech nique which we believe results in a more natural appearance in this area. OPERATIVE TECHNIQUE In raising the big abdominal skin flap, a cir cular incision is made as usual around the um- bilicus and the latter is left attached to the abdominal musculature, as in most abdomino- plastics. Our technique begins after the abdomi noplasty is complete, except for exteriorizing the navel , Carlos Juri, M-D., and Gustavo Raiden, M.D. The point for the exteriorization has been marked before, of course, At this time, we ae the medial and Tateral edges of a small, superiorly-based, triangular skio flap which has its apex ar the point marked previously as the eenter of the exteriorization. The shape of the fap is that of an equilateral triangle, «wo cm on each side (Fig. 14, Fig. 2, above lef). Because the abdominal skin is under some’ tension at this time, the V-shaped incision for the triangular fap will gape (Fig. 12, Fig. 2, above loft center Next, with 2 scissors we dhin the abominal skin flap (by excising fat from its undersurface) for an area ex Tending 6 cn sbove and 3-cm below the umbilical zone (Fig. 16, Fig. 2 above right center). Care is taken to leave a layer of fat in this area about one am thick, $0 as to avoid necrosis or adherence of the skin ((o the lunderlying aponeurosis). Fic. 1. The steps of our technique, shown dlagramamatically, 580Vol. 63, No. 4 | anpomunoptasty 581 Fe, 2 The technique, shown by intraoperative photographs Now one marks the lower margin of the expanded Vshaped incision in a eizeular shape (Fig. ID, Fig above right) and “deepithelizes” the intervening skin Gig. 12, Fig, 2, below lef) After one obtains good hemostasis, the umbilicus is exterforized and vertical radius is marked at 12 o'clock (Fig. 1F, Fig. 2, betow left center). A ent i made through the umbilicus along this radius (Fig. 1G, Fig, 2, Below right center) and, alter the separation gapes in the umbilicus, the iangular flap is sewed into this area (Fig. 17, Fig. 2, below right), Finally, the periphery of Fic. 8. The periumbilcal depression i shown 6 months postoperatively the umbilicus is approximated 10 the periphery of the ‘decpithelied area” with haléburied sutures, DISCUSSION With this easy technique, one can achieve the following improvements in the result (1) The avoidance of a circular scar which, in some cases, can constrict and deform the navel (2) The reproduction of the normal promi- Fie, 4 A case one month postoperatively.582 ¥ Tio, 5, Another case 6 months postoperatively. nence (or “knot”) in the upper part of the um- bilicus (3) A natural-appearing periumbilical depres- sion, especially in the supraumbilical area ‘We have been pleased with the results obtained (Figs. 3-6) SUMMARY ‘We present a new technique for umbilical reconstruction in abdominoplasty. José Juri, MD. Cervinto 3267 Buenos Aires, Argentina PLASTIC & RECONSTRUCTIVE suRGERY, April 1979 ‘ic, 6, Another cate, one year postoperatively. REFERENCES: Converse, J. M: Excess adipote tssue in the abdominal wall Tn Reconstructive Plastic Surgery. Volume V. P- 1951, W. B. Stunders Co,, Philadelphia, 1964, Lewis, J. Re Atlas of Aesthetic Plastic Surgery, p- 259 Tittle, Brown & o,, Boston, 1973, Prudente, As Dermolipectomin_ abdominal com conser ‘acho da cicatric umbilical. In ‘Trans. Second Cong. Lavine Americano Cir. Plast, pp. 468-470, 1942 Vernon, $2 Umbilical trangplantation upward_and ab: dominal contouring in. ipectomy. Am. J. Surg, 9 490, 1957 Favre, Je Liombilic dans la chirurgie esthetique de Tabdomen. In Precie de Chirurgie Bsthetigue, p. 187. Maloine, Paris, 1976