Trisquel neoumbilicoplasty: three-flap spiral reconstruction in abdominal wall reconstruction patients

Neoumbilical reconstruction after complex abdominoplasty or abdominal wall reconstruction (AWR) remains inadequately addressed by conventional techniques, which anchor cutaneous flaps to the anterior rectus fascia and require aggressive defatting to the deep fascia - principles incompatible with the presence of surgical mesh and with the compromised vascular territory of the post-abdominoplasty abdominal wall. We describe the Trisquel neoumbilicoplasty, a three-flap spiral technique designed to provide a reproducible and AWR-safe reconstructive option for high-risk patients in whom umbilical preservation is not feasible.

The technique is performed as a delayed procedure, no earlier than three months after the index operation, under local anesthesia in an office setting. A central 15 mm circle with three curvilinear arms at 120° separation is marked over the neoumbilical position. Three strictly cutaneous flaps are elevated in the plane of Camper's fascia, preserving the full thickness of subcutaneous fat and the subdermal vascular plexus. A central pocket is then created down to the deep surface of Scarpa's fascia, which is rigorously preserved as the anchoring substrate; the lateral cellular walls of the pocket are deliberately left intact. Three absorbable monofilament sutures invert and anchor each flap tip to Scarpa's fascia. A small intradermal antiseptic gauze bolster is secured in place with a tie-over suture and removed on postoperative day 5.

The technique was performed in 15 consecutive patients (13 female, 2 male; mean age 45.9 ± 9.0 years; mean body mass index 27.4 ± 3.0 kg/m²), with a follow-up ranging from 22 to 46 months (mean 30.5 ± 6.6 months). Eight patients (53.3%) had previous polypropylene mesh placement for abdominal wall reconstruction. Flap viability was preserved in all cases, and no mesh-related complications, deep surgical site infections, reoperations, or cases of progressive flattening were observed. Minor complications occurred in 4 patients (26.7%), all of them mesh-bearing and with clustered high-risk features (active smoking, body mass index ≥ 30 kg/m², or diabetes mellitus); all four were limited subcutaneous seromas managed by percutaneous aspiration, without impact on the underlying hernia repair. Final morphological outcome was graded as excellent in 9 patients (60.0%) and good in 6 (40.0%).

The Trisquel neoumbilicoplasty is a reproducible three-flap spiral technique specifically designed for the constraints of abdominal wall reconstruction. The three cutaneous flaps behave biologically as pedicled dermo-cutaneous grafts, an analogy borrowed from mucogingival and maxillofacial surgery that explains their consistent survival in compromised tissue beds. The technique offers a safe reconstructive option at the intersection of hernia surgery and body contouring, an area currently underserved by the neoumbilicoplasty literature.