Authors: Magnus Balslev Avnstorp, MD, Mette Ydo Jacobsen, Med. Stud., Anne Mosebo, MD, Julie Tastesen, MD and Emir Hansanbegovic, MD
Step 1: Preoperative images
Preoperative drawing with the patient standing in upright position.
Step 2: Preoperative images
Preoperative drawing with the patient standing and lifting the excissive abdominal skin.
Step 3: Preoperative
The patient in supine position.
Step 1: Dissection of the umbilicus
Carefully cut trough the skin while stretching the umbilicus.
Step 2: Dissection of the umbilicus
Dissect the umbilicus while paying attention to the blood supply.
Step 3: Dissection of the umbilicus
Dissect all the way through fat and fascia without jeopardizing the blood to the top of the umbilicus.
Step 4: Incisions
Make an incision following the inferior incision line. Do not yet incise the superior line.
Step 5: Dissection the fascia of Scarpa
Using the monopolar cauterizer perform hemostasis while dissecting down to the desired level which is fascia of Scarpa.
Step 6: Dissection in cranial direction
Continue dissection in a cranial direction. Pass the umbilicus at the level of sliding tissue superficial to the abdominal rectus muscle. Preform hemostasis of larger perforating vessels with sutures. Perform hemostasis on smaller vessels with a cauterizer.
Step 7: Excissive skin removed
Before the excessive skin is removed control the size by pulling the skin.
Step 8: Suturing
Sutures should firstly be placed in fascia of Scarpa. Place the drains.
Step 9: Suturing
Place sutures in two layers in the dermal level of the umbilicus and abdomen. Firstly, with single interrupted inverted absorbable sutures. Secondly, with continuous absorbable sutures. The umbilicus should be placed in line with the most superior point of the iliac crest.
Step 10: One day after surgery
No signs of complications. There was around 30 ml in the drain.
- Addressing the hanging mons by suturing the scarpas fascia
- Excise the umbilicus first to avoid inducing lesions in the umbilical blood supply
- Control the drawn incision lines before excising the last part of excessive skin
- Leave a thin layer of tissue above the abdominal wall muscle to avoid seroma
- Do not end the stitches in the T-junction of the abdomen, as this area has the least blood supply
- Compromising the blood supply to the umbilicus
- Stretching the skin too tight