Pediatric umbilical hernia is classified according to the facial defect diameter into three classes: class I, in which the defect I less than 1.5 cm, class II, in which the defect diameter ranges between 1.5 and 3 cm, and class III, in which the defect diameter is more than 3 cm. With the exception of class I hernias, which usually close by 5 years of age without interference, larger defects of classes II and III do not close without surgical repair 2,6.
The proboscoid variety of umbilical hernia protrudes through the fascial defect with downwards growth. Treatment of proboscoid umbilical hernia in children includes two steps: umbilical ring closure and aesthetic reconstruction of the umbilicus 6. It should be corrected before school age to avoid psychological disturbances for the child 6.
The ideal umbilicoplasty creates a permanent, round-shaped depression in the mid-abdomen with minimum scar formation. The upper edge should have a slightly hooded skinfold 7,8. Many techniques have been reported in the literature for umbilicoplasty, and these techniques can be classified into suture fixation methods 4,9–13 and flap methods 14–18. Suture fixation methods are favorable for obese adults with thick deposits of subcutaneous fat. However, these methods are inappropriate for pediatric patients and adolescents with a thin layer of subcutaneous fat. Conversely, flap techniques permit creation of a deep umbilical depression 16.
Simple and easily performed methods that are reported in the literature do not give much attention to aesthetic umbilical reconstruction, although they solve the problem of skin redundancy 19,20.
Our study on the umbilical skin ‘Y-to-V’ plasty gives attention to aesthetic surgery together with repair of the fascial defect as well as provides optimal, different umbilical cosmetic criteria.
Maintaining the umbilical rim is essential in our technique, and it is one of the determinant factors in the aesthetic aspect of the umbilicus. It gives the neo-umbilicus its diameter. It is elevated in infants and young children and becomes flattened when the abdominal panniculus becomes thickened. In our study, symmetric flaps with equal basis and equal height gave the advantage of having an ideal, regular, and complete rim.
Central depression is another determinant factor in the cosmetic aspect of the umbilicus. Its depth gives the umbilicus its normal shape. In our technique, suture fixation of the flap’s summit to the aponeurosis creates this depression. One of the essential aspects and challenges of all the techniques of umbilicoplasty is the avoidance of an added scar. Surgeons try to create a neo-umbilicus similar to the normal one, without additional scars, if possible. The Y-to-V umbilicoplasty allows having a neoumbilicus with minimal scarring.
The excision of redundant skin has to be performed carefully with meticulous technical procedures. The equal lengths of the ‘V’ segments are of most importance aesthetically. This resection is performed using the isosceles triangle design for skin excision. These lateral symmetrical triangles have their lower bases coexisting with the umbilical groove.
We did not encounter wound infection in our study because we used slow resorption suture for orifice closure.
An important advantage of this method is that it can be easily performed, and that it produces a normal-appearing umbilicus. Moreover, the technique leaves an unremarkable scar.
Y-to-V umbilicoplasty in the surgical repair of proboscoid umbilical hernia in pediatric patients is simple and easy to design and perform. This technique maintains the normal umbilical structure and produces a normal-appearing umbilicus with excellent aesthetic results, as well as optimal repair of a hernia defect.
Conflicts of interest
There are no conflicts of interest.
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