Scarless reconstruction of circular umbilical defects after resection of endometriosis

L Brandi, Daniel Rein, C. Nestle-Krämling, W Janni, MC Fleisch
In: Geburtshilfe und Frauenheilkunde · 2010 · vol. 70(11) · doi:10.1055/s-0030-1269940 · W2318665782
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This paper describes a scarless surgical technique using mobilized skin flaps to reconstruct circular umbilical defects after endometriosis resection, achieving satisfying cosmetic results.

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This paper describes a surgical technique for reconstructing circular umbilical defects following the complete excision of cutaneous endometriosis lesions. The method involves wide excision down to the rectus fascia, mobilization of defatted skin flaps, and attachment of an apical flap to the muscle with non-resorbable sutures. Two lateral flaps are then folded centrally and sutured to form a neo-umbilicus without additional incisions, allowing for concurrent diagnostic laparoscopy if needed. Clinical outcomes reported in the study indicate uneventful wound healing and cosmetically satisfying results for patients. This paper is centrally about endometriosis — specifically the management of umbilical cutaneous lesions and subsequent cosmetic reconstruction.

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Abstract

Objective: Approximately 0.5–1% of patients diagnosed with endometriosis present with cutaneous lesions in the umbilicus. For symptomatic patients complete excision is mandatory and frequently results in resection of the entire umbilicus. The resulting circular defects require umbilical reconstruction to achieve a cosmetically satisfying result in these mostly young patients. Methods: We report on our surgical technique of choice used in patients with circular defects in projection of the umbilicus. The umbilical mass is widely excised down to the level of the fascia of the rectus muscle. When indicated diagnostic laparoscopy can be performed using the same incision. Defatted skin flaps of the surrounding tissue are mobilized and the apical flap is attached to the aponeurosis of the rectus muscle using non-resorbable suture. Without further incisions two lateral flaps are folded in the centre and attached to fascia using two non-resorbable stitches forming a 'neo'-umbilicus. Results: Postoperative course and wound healing was uneventful. The cosmetic result was satisfying for the patients. Conclusion: We report about a simple surgical technique applicable in patients with circular defects in projection of the umbilicus, which provides satisfying cosmetic results without prominent visible scars. Supplementary laparoscopic inspection of the abdominal cavity can be performed without further incisions.
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Subscribe to RSS DOI: 10.1055/s-0030-1269940 Scarless reconstruction of circular umbilical defects after resection of endometriosis Objective: Approximately 0.5–1% of patients diagnosed with endometriosis present with cutaneous lesions in the umbilicus. For symptomatic patients complete excision is mandatory and frequently results in resection of the entire umbilicus. The resulting circular defects require umbilical reconstruction to achieve a cosmetically satisfying result in these mostly young patients. Methods: We report on our surgical technique of choice used in patients with circular defects in projection of the umbilicus. The umbilical mass is widely excised down to the level of the fascia of the rectus muscle. When indicated diagnostic laparoscopy can be performed using the same incision. Defatted skin flaps of the surrounding tissue are mobilized and the apical flap is attached to the aponeurosis of the rectus muscle using non-resorbable suture. Without further incisions two lateral flaps are folded in the centre and attached to fascia using two non-resorbable stitches forming a 'neo'-umbilicus. Results: Postoperative course and wound healing was uneventful. The cosmetic result was satisfying for the patients. Conclusion: We report about a simple surgical technique applicable in patients with circular defects in projection of the umbilicus, which provides satisfying cosmetic results without prominent visible scars. Supplementary laparoscopic inspection of the abdominal cavity can be performed without further incisions.

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endometriosis

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