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      Determining anatomical position of the umbilicus in Iranian girls, and providing quantitative indices and formula to determine neo-umbilicus during abdominoplasty

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          Abstract

          Background and Aim:

          The umbilicus plays an important role in the aesthetic appearance of the abdomen. So, its restoration during reconstructive surgeries, such as an abdominoplasty, is a challenge. The aim of this study was to evaluate quantitative indices based on constant skeletal points in the anterior wall of abdomen in order to provide an appropriate site of a neo-umbilicus during an abdominoplasty.

          Materials and Methods:

          In this descriptive, cross-sectional study, we enrolled 65 young adult girls (20–25 years old) who were nulliparous, nulligravid, and without any history of surgery. Weight, height, distance from xiphoid to umbilicus (Xu), distance from the pubic symphysis to xiphosternum (Xp), and anterior superior iliac spine (interASIS) distance of the subjects were measured. Data were analysed by SPSS ver. 16 using descriptive statistics and multiple regression tests in order to present a formula (equation).

          Results:

          Mean age was 22.74 ± 1.51 years, mean weight 54.98 ± 6.51 kg, mean height 160.91 ± 4.11 cm and body mass index (BMI) was calculated to be 21.25 ± 2.61 kg/m 2. Mean Xp distance was 32.26 ± 2.23 cm and mean Xu distance was 17.11 ± 1.64 cm. Xu/Xp ratio (ratio of umbilicoxiphoid distance to puboxiphoid distance) was 53.06 ± 3.9%. Data were analysed using multiple regression test and likelihood ratio. The formula used in determining the appropriate site of neo-umbilicus during abdominoplasty was suggested: Xu=−0.98 + 0.91Xp − 0.07H.

          Conclusion:

          By applying these quantitative methods, the natural site of neo-umbilicus could be determined. This may reduce practice errors and increase patient satisfaction. In addition, these findings provide plausible evidence to defend against possible legal complaints.

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          Most cited references 15

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          Placement of the umbilicus in an abdominoplasty.

           D Ousterhout,  R Dubou (1978)
          The location of the umbilicus was measured in 100 randomly selected non-obese subjects. It was found that a line drawn from the highest level of the crest of one ilium to the same point on the other side will transect the umbilicus in 96 percent of the subjects. This relationship can be of use during an abdominoplasty, when determining the location for the umbilicus.
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            Anatomical localization of the umbilicus: an Indian study.

            The umbilicus is essential to the aesthetic appearance of the abdomen. However, very little has been written about the exact location of the aesthetically pleasing umbilicus as far as the Indian cosmopolitan population is concerned. Although a variety of reconstructive methods are available, no real standards define the location of the umbilicus. In this study, 75 cosmopolitan female volunteers were evaluated in supine position, and the distance of the umbilicus (from central stalk) to fixed bony points over the anterior abdominal wall was measured. These linear measurements were subjected to standard statistical methods. In this study, the authors observed that the umbilicus is situated around the midline plane such that the ratio of the distance between the xiphisternum and the umbilicus and the distance between the pubic symphysis and the umbilicus is 1.6:1; also, the ratio of the distance between the umbilicus and anterior superior iliac spine and the inter-anterior superior iliac spine is approximately 0.6:1. During umbilicoplasty, when each anterior superior iliac spine is taken as a center, and arcs are drawn with a radius 0.6 times that of the inter-anterior superior iliac spine distance, the point of intersection of these arcs is the approximate location of the umbilicus around the midline plane, which should match the ratio of 1.6:1 (i.e., the ratio of the distance from the umbilicus to the xiphisternum and the distance from umbilicus to the pubic symphysis). An effort is made to find and establish the body proportions and symmetry and to determine the critical ratios so as to help the reconstructive surgeon to plan an aesthetically pleasing umbilicus.
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              Is the umbilicus truly midline? Clinical and medicolegal implications.

              A common misconception is that the umbilicus is a midline structure. To date, an anatomical survey examining whether the umbilicus is located at the midline has not been reported. This study measured the position of the umbilicus among 136 subjects, in two separate experiments. The results demonstrated that the umbilicus was not at the midline for nearly 100 percent of subjects and was more than 2 percent from the midline for more than 50 percent of subjects. This finding is of great importance for patient counseling in preoperative and postoperative settings. Because the discerning eye has repeatedly been demonstrated to be able to detect smaller asymmetries, these findings are significant and should be discussed with patients undergoing cosmetic abdominoplasty or reconstructive procedures, for preoperative informed consent. Education and preoperative demonstration can help prevent medicolegal ramifications. The umbilicus is rarely midline and, when critically analyzed, is located lateral to the midline axis more often than not.
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                Author and article information

                Journal
                Indian J Plast Surg
                Indian J Plast Surg
                IJPS
                Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
                Medknow Publications & Media Pvt Ltd (India )
                0970-0358
                1998-376X
                Jan-Apr 2012
                : 45
                : 1
                : 94-96
                Affiliations
                Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran
                [1 ]Medical Doctor, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
                [2 ]Medical Doctor, Students’ Research Committee, Urmia University of Medical Sciences, Urmia, Iran
                [3 ]Department of Psychiatry, Charles Drew University, UCLA, Los Angeles, USA
                Author notes
                Address for correspondence: Dr. Nariman Sepehrvand, National Institute of Health Research, Tehran University of Medical Sciences, No. 78, Italia Street, Keshavaraz Boulevard, Tehran, Iran. E-mail: nariman256@ 123456gmail.com
                Article
                IJPS-45-94
                10.4103/0970-0358.96594
                3385408
                22754161
                Copyright: © Indian Journal of Plastic Surgery

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Original Article

                Surgery

                umbilicus, abdominoplasty, neo-omphaloplasty

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