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Secondary Abdominoplasty: Management of the Umbilicus after Prior Stalk Transection

Dean, Riley A., M.D.; Dean, John A., M.D.; Matarasso, Alan, M.D.

Plastic and Reconstructive Surgery: April 2019 - Volume 143 - Issue 4 - p 729e-733e
doi: 10.1097/PRS.0000000000005415
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Summary: Patients with prior umbilical stalk detachment, secondary to limited abdominoplasty or prior umbilical hernia repair, may in the future be candidates for full abdominoplasty. In these patients, a circumferential incision around the umbilicus detaches the remaining cutaneous blood supply, prompting concern for umbilical viability. Minimal literature exists to guide clinical decision-making for these patients. Inquiries were made to Louisiana Society of Plastic Surgery members and the Plastic Surgery Education Network online forum of the American Society of Plastic Surgeons. Metrics obtained included patient age, sex, nature of primary surgery, time between umbilical stalk detachment and secondary full abdominoplasty, complications, and whether rectus plication was performed at the time of secondary surgery. Eleven physicians provided complete documentation for 18 cases. All patients healed without evidence of umbilical ischemia or necrosis. Average patient age was 40.6 years. Average interval between procedures was 3.6 years. Sixty-seven percent of patients had the umbilicus delayed before the secondary procedure, with the median delay time being 18 days. Rectus fascia was plicated during secondary surgery in 72 percent of patients. This is the first reported series of patients undergoing full abdominoplasty after prior umbilical stalk detachment. It is also the first time the Plastic Surgery Education Network online forum has been used to collect research data, highlighting its potential as a valuable research tool. The data set was obtained from a wide range of practices, which allows for consideration of various technical solutions when this or other diverse clinical scenarios are encountered.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

San Diego, Calif.; Baton Rouge, La.; and New York, N.Y.

From the Division of Plastic Surgery, Department of Surgery, University of California San Diego Medical Center; Associates in Plastic Surgery; and Hofstra Northwell Health System, Manhattan Eye, Ear, and Throat Hospital.

Received for publication April 21, 2018; accepted September 6, 2018.

Presented at the 60th Annual Scientific Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons, in Sea Island, Georgia, June 11 through 15, 2017; and at Plastic Surgery The Meeting 2017, Annual Meeting of the American Society of Plastic Surgeons, in Orlando, Florida, October 6 through 10, 2017, where it was selected as a “Top-Rated Poster.”

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Alan Matarasso, M.D., 1009 Park Avenue, New York, N.Y. 10028, amatarasso@drmatarasso.com

Copyright © 2019 by the American Society of Plastic Surgeons