Case and Research Letters
Neoumbiliconeoplasty With a Vertical Island Pedicle Flap
Neoumbilicoplastia mediante plastia en isla vertical
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Extirpación amplia de la lesión con 2 cm de margen. B. Defecto quirúrgico de 40 x 30 mm. C. Planificación de la reconstrucción con un colgajo pediculado en isla, se calcula el eje menor del huso equiparándolo al que deja un cierre transitorio en bolsa de tabaco (x) y la longitud del eje mayor siendo tres veces éste (3 x) que discurre por la línea media del defecto (línea discontinua gris). D. Se libera la bolsa de tabaco, y retiran triángulos laterales dejando isla de piel circular que se diseca junto con un pedículo adiposo que permita su movilización al punto deseado.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Vergara de la Campa, A. Brinca, A. Pinho, R. Vieira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Vergara de la Campa" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Brinca" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Pinho" ] 3 => array:2 [ "nombre" => "R." 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Solitary, indurated, crusty plaque on the forehead.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Costin, F. Bonito, J. Alves, H. Barreiros" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Costin" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Bonito" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Alves" ] 3 => array:2 [ "nombre" => "H." 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Vergara de la Campa, A. Brinca, A. Pinho, R. Vieira" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Vergara de la Campa" "email" => array:1 [ 0 => "laura.vergara.de.la.campa@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Brinca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Pinho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Vieira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario de Toledo, Toledo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neoumbilicoplastia mediante plastia en isla vertical" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 517 "Ancho" => 1255 "Tamanyo" => 102753 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Clinical image showing an asymmetric melanocytic lesion with irregular borders and heterochromia. B, Dermoscopic image showing a melanocytic lesion with an atypical pigment network, blue-gray dots, and whitish areas.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Malignant umbilical skin lesions, although infrequent, usually require treatment that includes partial or total omphalectomy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Given the esthetic importance of the umbilicus in the abdominal wall, its reconstruction must be considered when planning surgical treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Neoumbilicoplasty with an island pedicle flap can be performed in parallel with the omphalectomy, and provides adequate esthetic results. Although well described in dermatology for the reconstruction of central facial defects, the use of this technique in this anatomical location has been described on only a few occasions.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case Description</span><p id="par0015" class="elsevierStylePara elsevierViewall">An 82-year-old patient was evaluated for the growth of an asymmetric, melanocytic umbilical lesion (12 × 6 mm) with irregular borders and heterochromia, and, on dermoscopy, an atypical pigment network, grayish-blue dots, and whitish areas (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A partial biopsy was performed given the patient’s initial refusal to undergo surgery. Histology revealed a predominantly in situ, superficial spreading melanoma, with extensive underlying regression and an invasive component of 1.25 mm thick, without ulceration or mitotic activity. Wide excision with 2-cm margins was scheduled. A tumor extension study, including inguinal ultrasound and computerized axial tomography, revealed no findings of relevance. The patient refused to undergo a sentinel node biopsy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">Under local anesthesia, circular excision of the lesion is performed first (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Next, the size of the defect is reduced (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B) using a transient subcutaneous purse-string suture to calculate the size of the plasty (x) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). A spindle-shaped incision is designed with the major axis coinciding with the central point of the defect. The length of the major axis is 3 times that of the defect (3x), while that of the minor axis corresponds to the length of the defect (x) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A tobacco pouch is created to facilitate subsequent resection of the lateral triangles and dissection of the island, providing a subcutaneous pedicle long enough for transfer to the site of the defect (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D). The pedicle is fixed to the anterior rectus abdominis sheath using a transfixing U-stitch with a 3−0 polydioxanone suture, lending the plasty the conical shape of the umbilicus. The perimeter of the neo-umbilicus is sutured to the surrounding skin using loose stitches and the rest of the incision using a continuous running 4−0 suture (polyamide 6) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient underwent antibiotic prophylaxis with a single dose of oral cephradine (2 g) 30 min before surgery and a compression bandage was applied for 48 hours, followed by regular wound care. The sutures were removed after 2 weeks (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B) and the patient was subsequently followed for 10 months with no complications (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">The techniques used to create a neo-umbilicus vary in design and technical complexity. The main techniques used are plasties (Borges technique, V plasty, C–V plasty, unfolded cylinder plasty, lunch-box-type plasty, double V–Y plasty), using rotation flaps, triangular flaps, reverse fan-shaped flaps, island flaps, M-shaped or inverted omega-shaped flaps, and, less frequently, grafts.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Complications of these procedures include necrosis of the plasty, infections, hematoma formation, suture dehiscence, scar hypertrophy, and umbilical flattening.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Plasty with an island pedicle flap offers a series of advantages including concordance of color, texture, and thickness of the tissues, and avoids the compromise of other anatomical areas.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Plasty is performed with a generous vascular pedicle, reducing the possibility of necrosis, and involves little tension during closure, therefore reducing the likelihood of dehiscence. Moreover, recovery time is relatively short. Many of the more common techniques, particularly those that leave no visible scars and have excellent esthetic results,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> use healthy abdominal skin, and therefore need not contemplate the removal of a pre-existing umbilicus, periumbilical lesions, small surgical defects, or excess skin resulting from a hernia when constructing the neo-umbilicus. Plasty with an island pedicle flap allows concealment of moderate-sized defects such as that resulting from omphalectomy, and can be performed as part of the same surgical procedure under local anesthesia, ensuring a very adequate esthetic result. For this anatomical location, island plasty has been described using a horizontal orientation, whereby the skin of the island is included in the incision closure and a central transfixing point,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> or a vertical orientation, in which skin is taken from the area adjacent to the lesion and transformed into a conical shape.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We feel that the vertical orientation promotes better closure with less tension and provides a preferable esthetic result. Moreover, the use of a transfixing U-stitch facilitates the conical transformation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we propose island plasty with a vertical orientation and a central transfixing stich as a simple, safe, and esthetic technique for umbilical reconstruction after oncological surgery.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">This work did not receive any type of funding.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Description" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Technique" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-10-15" "fechaAceptado" => "2020-02-09" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vergara de la Campa L, Brinca A, Pinho A, Vieira R. Neoumbilicoplastia mediante plastia en isla vertical. Actas Dermosifiliogr. 2020;111:899–902.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 517 "Ancho" => 1255 "Tamanyo" => 102753 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Clinical image showing an asymmetric melanocytic lesion with irregular borders and heterochromia. B, Dermoscopic image showing a melanocytic lesion with an atypical pigment network, blue-gray dots, and whitish areas.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1008 "Ancho" => 1255 "Tamanyo" => 306111 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Wide excision of the lesion with 2-cm margins. B, Surgical defect (40 × 30 mm). C, Planning of reconstruction using an island pedicle flap. The minor axis of the spindle-shaped incision is calculated to ensure a transitory tobacco-pouch closure (x). The major axis is 3 times the length of the minor axis (3x) and runs along the midline of the defect (gray dashed line). D, The tobacco pouch is released, and the lateral triangles are removed, leaving a circular skin island that is dissected together with an adipose pedicle that enables its movement to the desired position.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 516 "Ancho" => 1255 "Tamanyo" => 92280 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The island is moved to the desired position and fixed to the anterior sheath of the rectus abdominis muscle with a transfixing U-stitch to give it a conical shape. The skin surrounding the neo-umbilicus is sutured with loose stitches and the remainder with a continuous running suture. A, Immediate postoperative result. B, After suture removal, 14 days later. C, Ten months after the surgical intervention.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Umbilical Lesions: Clinicopathologic features of 99 tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Yan" 1 => "S. Sethi" 2 => "P. Bitterman" 3 => "V. Reddy" 4 => "P. Gattuso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1066896918758916" "Revista" => array:7 [ "tituloSerie" => "Int J Surg Pathol." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 4 | 9 |
| 2024 October | 63 | 41 | 104 |
| 2024 September | 74 | 19 | 93 |
| 2024 August | 103 | 53 | 156 |
| 2024 July | 76 | 34 | 110 |
| 2024 June | 92 | 28 | 120 |
| 2024 May | 96 | 37 | 133 |
| 2024 April | 77 | 35 | 112 |
| 2024 March | 91 | 30 | 121 |
| 2024 February | 54 | 32 | 86 |
| 2024 January | 67 | 33 | 100 |
| 2023 December | 62 | 19 | 81 |
| 2023 November | 104 | 32 | 136 |
| 2023 October | 75 | 23 | 98 |
| 2023 September | 61 | 38 | 99 |
| 2023 August | 43 | 26 | 69 |
| 2023 July | 85 | 60 | 145 |
| 2023 June | 75 | 28 | 103 |
| 2023 May | 124 | 19 | 143 |
| 2023 April | 88 | 23 | 111 |
| 2023 March | 97 | 35 | 132 |
| 2023 February | 67 | 31 | 98 |
| 2023 January | 59 | 29 | 88 |
| 2022 December | 67 | 47 | 114 |
| 2022 November | 46 | 44 | 90 |
| 2022 October | 37 | 33 | 70 |
| 2022 September | 62 | 48 | 110 |
| 2022 August | 52 | 43 | 95 |
| 2022 July | 32 | 30 | 62 |
| 2022 June | 37 | 22 | 59 |
| 2022 May | 80 | 54 | 134 |
| 2022 April | 62 | 40 | 102 |
| 2022 March | 54 | 64 | 118 |
| 2022 February | 49 | 30 | 79 |
| 2022 January | 80 | 46 | 126 |
| 2021 December | 82 | 52 | 134 |
| 2021 November | 63 | 46 | 109 |
| 2021 October | 69 | 75 | 144 |
| 2021 September | 74 | 51 | 125 |
| 2021 August | 46 | 33 | 79 |
| 2021 July | 48 | 32 | 80 |
| 2021 June | 49 | 30 | 79 |
| 2021 May | 47 | 53 | 100 |
| 2021 April | 102 | 70 | 172 |
| 2021 March | 60 | 51 | 111 |
| 2021 February | 66 | 34 | 100 |
| 2021 January | 64 | 48 | 112 |
| 2020 December | 50 | 25 | 75 |
| 2020 November | 19 | 8 | 27 |
| 2020 October | 7 | 4 | 11 |
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