Advancement flap umbilicoplasty after abdominal wall closure: Postoperative results compared with normal umbilical anatomy

Background/Purpose: Umbilical reconstruction frequently is an adjunct used after repair of congenital abdominal wall defects. The authors describe a n ew technique of umbilicoplasty and compare their results with normal neonat al umbilical anatomy. Methods: After fascial closure, 6 newborn infants with either gastroschisis (n = 3) or omphalocele (n = 3) underwent umbilicoplasty performed by advan cing bilateral skin flaps including creation of an umbilical skin collar. T he umbilical collar height, circumference, and distance from the xiphoid wi th respect to the pubis (ratio of xiphoid-umbilicus distance to xiphoid-pub is distance or XU:XP) were recorded and referenced to normal umbilical anat omy in additional 28 infants (24 to 40 weeks gestation [mean, 33.2 weeks] a nd age 2 to 131 days [mean, 26.5 days]). Results: After umbilicoplasty, all infants had a near-normal-appearing umbi licus (collar height, 0.75 +/-0.25 cm and circumference, 5.24 +/-1.20 cm) c ompared with normal umbilical anatomy (collar height, 4.36 +/-1.32 cm and c ircumference, 1.03 +/-0.38 cm). However, after umbilicoplasty, the neoumbil icus was positioned more cephalad (XU:XP = 0.53 +/- .05) compared with norm al (mean XU:XP, 0.67 +/-0.07). The only complication encountered was a smal l dehiscence of the superior aspect of the abdominal wound. Conclusions: Closure of abdominal wall defects with simultaneous umbilicopl asty provides a cosmetically pleasing result. When performing umbilicoplast y, attempt should be made to position the neoumbilicus as inferior as possi ble, optimally at two thirds the distance from the xiphoid to the pubis. J Pediatr Surg 36:1168-1170. Copyright (C) 2001 by W.B. Saunders Company.