Jayyosi L, Boudaoud N, Okiemy O, Correia N, Alanio-Detton E, Bory J P, Liné A, Poli-Merol M L, Mazouz Dorval S, Francois C
Chirurgie plastique reconstructrice et esthétique, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France.
Chirurgie pédiatrique, American Memorial Hospital, CHU de Reims, 47, rue Cognacq-Jay, 51100 Reims, France.
Ann Chir Plast Esthet. 2016 Oct;61(5):713-721. doi: 10.1016/j.anplas.2016.05.002. Epub 2016 Jun 8.
The umbilicus is our first scar. It is the last remain of our life in utero. Besides the umbilical hernia, a common pathology during the first three years of life that rarely requires surgery, there are some rare congenital abnormalities such as gastroschisis and omphalocele, which occur in about 1-5/10,000 births. Gastroschisis is a birth defect of the anterior abdominal wall, through which the fetal intestines freely protrude and are not covered by any membranes. During the 13th week prenatal ultrasound, the umbilical cord can be seen to be properly attached while the intestines float freely in the amniotic fluid. This defect is most common in young women who smoke and/or use cocaine and is not typically associated with genetic disorders. Omphalocele is an average coelosomy, in which a visceral hernia protrudes into the base of the umbilical cord. Omphalocele is typically diagnosed during the prenatal phase, and occurs most commonly in older mothers. It is frequently associated with genetic and morphologic abnormalities, therefore a karyotype should automatically be performed. For these two pathologies, the surgical problem lies in managing, during the reintegration, the conflict container/content responsible to lower vena cava syndrome and disorders ventilatory. Deciding on the technique will depend on the clinical form, and on the tolerance to reinsertion. The success of the surgery is directly linked to the postoperative emergence care for the pre-, per- and postnatal phases. The umbilical cord is preserved in the case of a gastroschisis. A primary or secondary umbilicoplasty will be performed for an omphalocele closure. The umbilicoplasty aims to create an umbilicus in a good position by giving it a shape, ideally oval, but also and especially an umbilication. The primary or secondary umbilicoplasty remains a challenge in a growing abdomen (change in position, deformation, loss of intussusception with growth). Many techniques are described: cutaneous flaps randomly placed, excision and skin plasty, resection and controlled wound healing. The choice of technique is a matter of practice but must be done in a rational way, depending on the scar condition when secondary reconstruction, and with minimal scarring, for primary reconstruction. To avoid morphological changes associated with growth, secondary umbilicoplasty should be proposed after the age of five.
肚脐是我们的第一道疤痕。它是我们子宫内生命的最后遗迹。除了脐疝，这是生命最初三年常见的病理情况，很少需要手术，还有一些罕见的先天性异常，如腹裂和脐膨出，其发生率约为每10000例出生中有1 - 5例。腹裂是前腹壁的一种出生缺陷，胎儿的肠道通过此处自由突出，且没有任何膜覆盖。在孕13周的产前超声检查中，可以看到脐带附着正常，而肠道在羊水中自由漂浮。这种缺陷在吸烟和/或使用可卡因的年轻女性中最为常见，通常与遗传疾病无关。脐膨出是一种平均型的体腔闭合不全，其中内脏疝突出到脐带基部。脐膨出通常在产前阶段被诊断出来，最常见于年龄较大的母亲。它常与遗传和形态异常相关，因此应自动进行核型分析。对于这两种病理情况，手术问题在于在重新整合过程中处理导致下腔静脉综合征和通气障碍的容纳物/内容物冲突。手术技术的选择将取决于临床形式以及对重新植入的耐受性。手术的成功与产前、产时和产后阶段的术后紧急护理直接相关。腹裂情况下脐带得以保留。脐膨出闭合时将进行一期或二期脐成形术。脐成形术旨在通过赋予其形状，理想情况下为椭圆形，尤其是形成脐凹，从而在合适的位置打造一个肚脐。在不断生长的腹部（位置改变、变形、生长导致套叠消失）进行一期或二期脐成形术仍然是一项挑战。有许多技术被描述：随机放置的皮瓣、切除与皮肤整形、切除与控制性伤口愈合。技术的选择是一个实践问题，但必须合理进行，取决于二期重建时的瘢痕情况，对于一期重建则要尽量减少瘢痕形成。为避免与生长相关的形态变化，二期脐成形术应在五岁以后进行。
