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13 Abdominoplasty (The Umbilical Lozenge Technique)

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Fig. 13.10 Flap positioned and sutured by layers. (a) Case 01. (b) Case 01 (enlarged look of the neo-navel

Fig. 13.11 Instalation of incisional VAC therapy. (a) Case 02. (b) Case 02 (enlarged look of the neo-navel)

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a b

Fig. 13.12 (a) Case 03. (b) Case 03 (enlarged look of the neo-navel)

Fig. 13.13 Case 04

(enlarged look of the neo-navel)

M. de OliveiraeSilva

Fig. 13.14 Case 05 (enlarged look of the neo-navel)

13 Abdominoplasty (The Umbilical Lozenge Technique)

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Fig. 13.15 (a) Case 06. (b) Case 06 (enlarged look of the neo-navel)

a b

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Fig. 13.16 (a) Case 07. (b) Case 07 (enlarged look of the neo-navel)

a b

Fig. 13.17 (a) Case 08. (b) Case 08 (enlarged look of the neo-navel)

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a b

Fig. 13.18 (a) Case 09. (b) Case 09 (enlarged look of the neo-navel

a b

M. de OliveiraeSilva

Fig. 13.19 (a) Case 10. (b) Case 10 (enlarged look of the neo-navel)

a b

Fig. 13.20 (a) Case 11. (b) Case 11 (enlarged look of the neo-navel)

13 Abdominoplasty (The Umbilical Lozenge Technique)

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a b

Fig. 13.21 (a) Case 12. (b) Case 12 (enlarged look of the neo-navel)

Fig. 13.22 Case 13

(enlarged look of the neo-navel)

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Fig. 13.23 Case 14 (enlarged look of the neo-navel)

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Fig. 13.24 Case 15 (enlarged look of the neo-navel)

M. de OliveiraeSilva

Fig. 13.25 (a) Case 16. (b) Case 16 (enlarged look of the neo-navel)

a b

Fig. 13.26 (a) Case 17. (b) Case 17 (enlarged look of the neo-navel)

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a b

Fig. 13.27 (a) Case 18. (b) Case 18 (enlarged look of the neo-navel)

Results

During the postoperative period, patients were followed up with weekly outpatient visits.

All complications related to healing of the umbilical region during the study were recorded in the medical records (Table13.1).

During the 6-month postoperative review consultation, each patient received a questionnaire to be answered outside the consultation, being returned to another surgeon in the team without identication, in order to avoid the partiality of the answers, informing, through this, their opinions about different aspects of the neonavel. Regarding the questionnaire answered by the patients at the 6-month review visit, the shape of the neo-navel was classied as “Very satised” by 30 (100%) patients. The position of the navel was another evaluated characteristic, receiving as a classication “Very satised” by 30 (100%) patients. In relation to the general aspect, 24 (100%) patients opined as “Very satised,” and another 6 (20%) opined as “Satised.”

The aspects addressed in the questionnaire and the classication given to them by the patients themselves are shown in Table13.2.

The 10 to 27 pictures illustrate some results of our series in which the lozenge omphaloplasty technique was used in horizontal abdominal dermolipectomies. Photos were taken by the author during the 6-month post-surgery review visit.

Table 13.1 Complications related to the umbilical region healing during the study

Dehiscence (total/partial) 0 (0%) Wound infection 0 (0%) Cutaneous necrosis 0 (0%) Enlarged scar 1 (3.3%) Keloid scar 0 (0%) Hypertrophic scar 6 (20%) Scar stenosis 0 (0%)

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Table 13.2 Patient satisfaction questionnaire with the new navel

Very satised Satised Indifferent Unsatised

Shape 30 (100%) 0 (0%) 0 (0%) 0 (0%) Position 30 (100%) 0 (0%) 0 (0%) 0 (0%) General aspect 24 (80%) 6 (20%) 0 (0%) 0 (0%)

M. de OliveiraeSilva

Discussion

Despite considerable advances in omphaloplasty techniques, we noticed that the scars generated are often still stigmatizing, compromising the result of abdominoplasty. In order to achieve natural results in this surgery, it is important that the new navel transmits an appearance similar to the original anatomy, with minimal visible scars and without stenosis (Furtado 2011). As described in the literature, this anatomy comprises a rounded or slightly elongated shape in the vertical direction, with a mean diameter of 1.2 to 1.8cm, and variable depth depending on the thickness of the adipose tissue of the abdomen. Its position is in the midline, at a height that varies from 4 cm above to 2cm below the horizontal line that passes through the anterosuperior iliac spines (Jaimovich etal. 1999; Ng 2010).

The technique presented is intended to reproduce these anatomical characteristics, using them in the vertical lozenge incision, in the release of the umbilical scar as in the skin-fat ap, in addition to the xation of the umbilical stump 0.5cm away from the skin to the aponeurosis so that the neo-navel has natural depth (Avelar

2016). In the studied series, this technique produced results with characteristics

similar to those mentioned above.

Although the pathophysiology of hypertrophic scars has not yet been fully elucidated, the genetic factor is relevant and prevents its complete prevention (Lorenz and Sina Bari 2012). This explains the appearance of hypertrophic scars in six cases, as shown in Figs.13.10, 13.13, 13.18, 13.22, 13.23, and 13.25. However, no cases of umbilical stenosis were identied among them. We attribute this fact to the fact that the diamond technique follows the idea of broken incisions proposed by Avelar (1979), reducing the incidence of stenosis resulting from circular incisions (Baroudi and Carvalho 1981).

The case shown in Fig.13.21 was the only one in which lines of enlarged scars were identied in the umbilical region.

Some authors include in their techniques the degreasing of the abdominal wall around the navel for more natural results (Castro etal. 2014). In the described technique, lipectomy is also adopted and occurs under direct vision and in a controlled manner, with easy access to posterior hemostasis. This step contributes to reducing the tension in the scars, in addition to forming a depression in the abdomen in the umbilical region, which simulates the umbilical groove and gives the abdomen a natural appearance.

Furthermore, in a teaching service, involved in the training practice of plastic surgeons by residents, it is essential to routinely adopt a technique that is simple to perform, has well-dened steps, and can be transmitted in a didactic way, with a low

13 Abdominoplasty (The Umbilical Lozenge Technique)

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incidence of postoperative complications, to facilitate learning and for all results to have a high-quality standard.

Skin healing is a known process. It is divided into three phases, which overlap and can last from 6months to a year: inammatory phase, proliferative phase, and maturation phase (Mélega etal. 2000). Based on this, this study involved the evaluation of scars in the sixth postoperative month.

For the evaluation of scars in general, subjective assessment scales, which are non-invasive and easy to handle, are considered clinically more useful. There are currently ve scar assessment scales that use subjective parameters in an objective way: Vancouver Scar Scale (VSS), Manchester Scar Scale (MSS), Patient and Observer Scar Assessment Scale (POSAS), Visual Analogue Scale (VAS), and Stony Brook Scar Evaluation Scale (SBSES) (Fearmonti etal. 2010). However, these scales are more appropriate for comparative assessments or for the analysis of clinical results after a specic intervention for the scar treatment (Durani et al.

2009). In this study, we chose to use a method that enabled the assessment of the

umbilical scar specically, covering all its aspects.

These questionnaires were given to each patient during the 6-month postoperative review appointments to be answered in private. In this way, we avoided that patients’ responses were inuenced by their possible embarrassment for being in the presence of their surgeon. Returning the questionnaires without identication avoided the measurement bias by the author.

Although the evaluation of patients’ satisfaction with the results of their surgeries is subjective and related to the expectations of each one of them, through the questionnaire used in this study, it was possible to obtain, in a simple and objective way, data which reect that the technique used produced results that considerably pleased all patients involved in the study. When analyzing the questionnaires, we considered that the “Satised” classication given by six patients for the general appearance of the neo-navel is due to the fact that they are the same ones that evolved with hypertrophic scars, inuencing the nal result in these cases.

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Conclusion

The lozenge omphaloplasty technique in abdominal dermolipectomy proved to be simple to perform and easy to learn, with a low incidence of postoperative complications, without cases of umbilical stenosis and with a high degree of patient satisfaction.

Appendix

Appendix 13.1 Study patient group characteristics

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Age (years) 28–42 35 (media) IMC (kg/m2) in the surgery day 25.46–29.22 27.34 (media) Gender Women 28 Men 2 Previous bariatric surgery Yes 18 (60%) No 12 (40%)

M. de OliveiraeSilva

References

Furtado IR.Onfaloplastia: técnica “innito”. Rev Bras Cir Plást. 2011;26(2):298–301 Jaimovich CA, Parra JFN, Pitanguy I.Semiologia da parede abdominal: seu valor no planejamento

das abdominoplastias. Rev Soc Bras Cir Plást. 1999;14(3):21–50. Ng JAA.Abdominoplastia: neo-onfaloplastia sem cicatriz e sem excisгo de gordura. Rev Bras Cir

Plбst. 2010;25(3):499–503. DOI: https://doi.org/10.1590/S1983- 51752010000300017 Avelar J.Creation of the new umbilicus: my technique on abdominoplasty and further applica-

tions. In: Avelar J, ed. New concepts on abdominoplasty and further applications. Switzerland:

Springer International Publishing. 2016; p.107–26 Lorenz P, Sina Bari A.Scar Prevention, treatment, and revision. In: Neligan PC, ed. Plastic Surgery.

3rd ed. Volume 1. Philadelphia: Elsevier Saunders; 2012. p.297–318. Avelar J.Cicatriz umbilical da sua importância e da técnica de confecçāo nas abdominoplastias.

Rev Bras Cir. 1979;69(1–2) 41–52. Baroudi R, Carvalho C.Neoumbilicoplastias. Um procedimiento ecletico em el transcurso de las

abdominoplastias. Cir Plast Iberolatinoam. 1981;7(4) 391–401. Castro DPR, Saldanha OR, Pinto EBS, Albuquerque FM, Moia SMS.Avaliação estética da cicatriz

umbilical em duas técnicas de onfaloplastia. Rev Bras Cir Plást. 2014; 29(2):248–52 Mélega, J.; Viterbo, F. and Mendes, F. (2000). Cirurgia plástica. 1st ed. Grupo Gen -

Guanabara Koogan. Fearmonti R, Bond J, Erdmann D, Levinson H.A review of scar scales and scar measuring devices.

Eplasty. 2010;10:e43. Durani P, McGrouther DA, Ferguson MW.Current scales for assessing human scarring: a review.

J Plast Reconstr Aesthet Surg. 2009;62(6):713–20. PMID: 19303834 DOI: https://doi.

org/10.1016/j.bjps.2009.01.080