Impact of umbilical fixation on perfusion in abdominoplasty: A hyperspectral imaging study

Postoperative necrosis of the umbilicus is a rare yet serious complication in abdominoplasty. Fixation of the umbilicus to the fascia (umbilicopexy) is commonly used to enhance aesthetic outcomes, but concerns regarding potential compromise to perfusion remain unaddressed. This study investigates the impact of umbilicopexy on umbilical perfusion using hyperspectral imaging (HSI), a non-invasive method for assessing tissue oxygenation and perfusion.

In this prospective study, 28 patients (25 female; mean age 42 years, range 24 to 60 years) undergoing abdominoplasty were assessed: 11 underwent umbilicopexy, while 17 served as controls. HSI parameters, including tissue oxygenation (StO₂), near-infrared perfusion index (NIR PI), tissue hemoglobin index (THI), and tissue water index (TWI), were recorded intraoperatively and on postoperative days (POD) 1 and 2. Clinical outcomes, including marginal wound necrosis and revision surgeries, were also documented.

StO₂ values were higher intraoperatively in the umbilicopexy group (80 ± 7 %) compared to the control group (68 ± 16 %; p = 0.025). By POD 1, StO₂ decreased in both groups (umbilicopexy: 66 ± 11 %, control: 56 ± 15 %, p = 0.067). Marginal wound necrosis occurred in 9 % of the umbilicopexy group and 18 % of controls (p = 1.0), while revision surgery related to perfusion deficits was required in none of the patients in both groups. No significant differences were found in NIR PI, THI, or TWI across groups or time points.

HSI proved valuable for real-time perfusion monitoring suggesting that Umbilicopexy is not adversely affecting umbilical perfusion or wound healing in abdominoplasty. Larger cohort studies with additional confounders are recommended to confirm these findings.