A new umbilicoplasty for children: creating a longitudinal deep umbilical depression  A. Kajikawa, K. Ueda, Y. Suzuki, M. Ohkouchi  British Journal of Plastic Surgery  Volume 57, Issue 8, Pages 741-748 (December 2004) DOI: 10.1016/j.bjps.2004.05.015

Figure 1 The conventional V-Y advancement flap method. (a) and (b) Design of the method. (c) and (d) Postoperative appearance. British Journal of Plastic Surgery 2004 57, 741-748DOI: (10.1016/j.bjps.2004.05.015)

Figure 2 The new method of umbilicoplasty. (a)–(d) A pair of long obliquely opposed flaps are designed. (e) and (f) Both flaps are elevated and the herniated orifice is closed. (g) and (h) The left and right flaps are sutured together to form a skin pouch. (i) and (j) The pouch is turned inside out and sutured along the linea alba. (k) and (l) Cranial and caudal donor sites are closed. British Journal of Plastic Surgery 2004 57, 741-748DOI: (10.1016/j.bjps.2004.05.015)

Figure 3 Case 7: a 3-year-old boy who had the protruding umbilicus, which was 15 mm in diameter. A small herniated orifice 5 mm in diameter was palpable in the umbilicus. (A) Preoperative view. (B) Design of the flaps. Sides of the square and each regular triangle were 15 mm. (C) and (D) The double flaps 32 mm in length were elevated. The fascial defects were closed longitudinally. (E) The left and right flaps are sutured together to make a skin pouch. (F) The skin pouch was turned inside out and sutured along the linea alba. (G) A longitudinal deep umbilical depression was created. (H) and (I) The direction of the depression is sagittally wide. (J) The natural-looking umbilicus was shown 1-year-after the operation. British Journal of Plastic Surgery 2004 57, 741-748DOI: (10.1016/j.bjps.2004.05.015)

Figure 4 Case 3: a 6-year-old girl had a protruding umbilicus, which was 17 mm in diameter. The hernia orifice was 5 mm in diameter. (A) Preoperative view. (B) 2-year and 1-month-after the operation. British Journal of Plastic Surgery 2004 57, 741-748DOI: (10.1016/j.bjps.2004.05.015)

Figure 5 Case 4: a 2-year-old boy had a large protruding umbilicus, which was 30 mm in diameter. The hernia orifice was 25 mm in diameter. (A) Preoperative view. (B) 2-year-after the operation. British Journal of Plastic Surgery 2004 57, 741-748DOI: (10.1016/j.bjps.2004.05.015)

Figure 6 Case 5: a 8-year-old boy had a protruding umbilicus, which was 15 mm in diameter. The hernia orifice was 5 mm in diameter. (A) Preoperative view. (B) 1-year and 3-month-after the operation. British Journal of Plastic Surgery 2004 57, 741-748DOI: (10.1016/j.bjps.2004.05.015)

Figure 7 Case 6: a 5-year-old boy had a protruding umbilicus, which was 15 mm in diameter. The hernia orifice was 5 mm in diameter. (A) Preoperative view. (B) 1-year and 1-month-after the operation. British Journal of Plastic Surgery 2004 57, 741-748DOI: (10.1016/j.bjps.2004.05.015)

Figure 8 The comparison between the conventional V-Y advancement flap methods and our new methods. (a) and (b) In the conventional V-Y advancement flap method, only a longitudinal scar line and shifted umbilical depression facing upward at the caudal end of the scar are formed. (c) and (d) In our new method, a longitudinal deep umbilical depression facing forward can be created at the correct position. ☆, The level of the original umbilicus. →, The direction of the created umbilical depression. British Journal of Plastic Surgery 2004 57, 741-748DOI: (10.1016/j.bjps.2004.05.015)