Tubularized trapezoid flap neoumbilicoplasty--simple technique for umbilical reconstruction in bladder exstrophy

Umbilical preservation or reconstruction of a neoumbilicus has now become a part of exstrophy repair. We describe an easy method of umbilicoplasty concurrent with the initial bladder closure or at subsequent stages and present our experience with this technique in 36 patients during the past 5 years.

Umbilical reconstruction using this technique was done in 36 patients (23 boys and 13 girls), with mean age of 1.5 years (range 2 days to 16 years). A superiorly based trapezoid skin flap was raised at the beginning of the procedure, with its base along a line joining the highest points on the iliac crests and leaving the umbilical remnant at the apex of the flap. At the end of the repair, the flap was vertically oriented and tubularized around the suprapubic and ureteral catheters. After removal of the catheters, the tubularized flap was allowed to follow the natural course of healing.

With a mean follow-up of 3 years (range 3 months to 5 years), all but 2 patients have developed a satisfactory dimpled umbilical scar. The sequence of events in the formation of an umbilical scar simulated that of the umbilical remnant in a newborn (ie, a cord to a proboscoid to a dimpled navel with a hidden central stalk). Even in the patients who developed wound infection, a cosmetic umbilicus was formed.

The technique is easy to perform, free of complications, and gives reproducible cosmetic results comparable to various other methods described in published reports.