Preoperative Umbilical Delay Procedure in Abdominoplasty Patients.
The delay phenomenon has been well described for optimization of flap survival in reconstructive surgery1. The physiologic basis of delay phenomenon entails dilation and reorientation of choke vessels after initial flap dissection. Ultimately, neovascularization results which promotes survival of tissues most prone to necrosis2. An aesthetically pleasing umbilicus is a central aesthetic component of abdominoplasty and critical to patient satisfaction. Patients with prior umbilical hernia repairs or laparoscopic procedures are at higher risk for umbilical necrosis following repositioning in abdominoplasty, ultimately compromising a good aesthetic outcome. We describe umbilicus delay technique as a bridge to optimize vascularity in high risk patients prior to abdominoplasty.
Methods/Technique:
A retrospective data of patients from January 2020 to October 2021, who underwent umbilical delay procedure was collected. The delay procedure was performed under local anesthetic in the minor treatment room 3-4 weeks prior to scheduled abdominoplasty. The procedure entails infiltrating the umbilicus with local anesthetic, followed by circumferential dissection down to the rectus abdominis fascia. Incision is then closed with simple interrupted sutures. Following the procedure, the patient underwent abdominoplasty as routine. Outcomes were assessed and reported.
Results/Complications:
A total of 6 female patients between the ages of 35-73 were identified. Four had prior umbilical hernia repair with mesh, one patient had umbilical hernia and one had umbilicus surgical scar from previous laparoscopic appendectomy. No significant medical comorbidities were present. All patients followed with either abdominoplasty or extended abdominoplasty with concomitant liposuction at a mean of 28 days post umbilicus delay procedure. One patient had to be delayed secondary to wound healing issues resulting from umbilicus delay. Following the abdominoplasty procedure, one patient required Nitropaste application to umbilicus for compromised blood flow. Other patients had no complications. All patients ultimately resulted in viable umbilicus and did not require subsequent revision.
Conclusion: The umbilical delay serves as a useful adjunct procedure in preparation for abdominoplasty in patients with prior history of umbilical hernia repairs.
- Myers M B, Cherry G. Mechanism of the delay phenomenon. Plast Reconstr Surg. 1969;44(1):52–57
- Hamilton K, Wolfswinkel EM, Weathers WM, et al. . The delay phenomenon: a compilation of knowledge across specialties. Craniomaxillofac Trauma Reconstr. 2014; 7:112–118