Simplified technique for creating a youthful umbilicus in abdominoplasty

Reimplantation of the umbilicus remains a critical aesthetic component in abdominoplasty and transverse rectus abdominis musculocutaneous breast reconstruction. Although the ideal shape of the umbilicus has been debated, recent studies have shown the young, thin female with an attractive abdomen tends to have a small, vertically oriented umbilicus. The aesthetic considerations for reimplantation include position, depth, shape, and location of scar. The authors present a technique that is expedient and reliable and that addresses each of these variables. The umbilicus is sutured to the rectus fascia and reimplanted through a vertical incision in the abdominal flap. Subdermal sutures are placed from the umbilicus to the linea alba superiorly and inferiorly. These sutures create a vertically oriented shape and place the umbilicus in the midline. Shortening the umbilical stalk establishes depth and hides the closure of the umbilicus and abdominal flap within the stalk. The stalk length is easily varied, depending on the thickness of the panniculus. Defatting is performed through the vertical incision to allow easy visualization of the umbilicus. This technique creates depth, ensures optimal position, pulls the scar deep in the umbilicus, and produces a vertically oriented, youthful umbilicus. More importantly, a questionnaire given to patients who have undergone abdominoplasty with this procedure (n = 21) confirms that patients have a high level of satisfaction with the resulting shape, position, and overall appearance.     

In search of the ideal female umbilicus

The umbilicus is essential to the aesthetic appearance of the abdomen. However, little research exists on what characterizes an aesthetically pleasing umbilicus. Often, the plastic surgeon is called on to reconstruct the umbilicus. Although a variety of reconstructive methods are available, no real standards define the appearance of an aesthetically pleasing umbilicus. To ascertain the characteristics of an aesthetically pleasing umbilicus, a photographic analysis was undertaken using 147 female participants between the ages of 18 and 62 years. Each subject's age, height, and weight were recorded. Photographs of each participant's umbilicus were then taken from 30 cm and 50 cm away. The photographs were reviewed by the authors, and each umbilicus was categorized on the basis of size, shape, hooding, or protrusion. The photographs were then reviewed by a panel and given a score between 1 and 10 to rate attractiveness. Using linear regression analysis, the effects of body mass index, shape, hooding, and umbilical protrusion on attractiveness were assessed. The T- or vertically shaped umbilicus with superior hooding consistently scored the highest in aesthetic appeal, whereas the presence of any degree of protrusion and a horizontal orientation or distorted shape detracted from the score. Those with a large umbilicus tended to score consistently lower than those with a smaller configuration. A desirable goal in umbilical reconstruction is, thus, to create a small T or vertically oriented umbilicus with the addition of a superior hood or shelf.     

An anatomical method for re-siting the umbilicus

The umbilicus is the only normal scar on the body and it is the most noticeable scar following abdominoplasty and TRAM or DIEP flap procedures. We describe a technique for resiting the umbilicus that attempts to recreate the anatomical structure by attaching the superficial fascia to the periumbilical skin to produce a fullness around the depression in which the umbilicus sits. This is aesthetically desirable and avoids the uncomfortable tethering of the umbilicus to the rectus sheath associated with other techniques.     

Placement of the umbilicus in an abdominoplasty

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.     

Two unusual umbilicoplasties.

We describe the creation of an umbilicus where none previously existed, during an abdominoplasty, and the cosmetic shaping of a stretched umbilicus after an umbilical hernia repair.     

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.     

Extensive intraspecific variation in a Triassic ammonoid from Siberia

The ammonoid species Czekanowskites rieberin.sp . from the Lower Anisian of Arctic Siberia (River Olenek) shows an enormous range of intraspecific variability. The 700 investigated specimens are packed in one single concretion. They are all adult with preserved living chambers and apertural structures. Morphologically they range from keeled smooth suboxycones with narrow umbilicus, through feebly ribbed platycones with a little wider umbilicus, to subcadicones with relatively wide umbilicus and straight ribs with bullae. The morphological variation is continuous; all specimmh belong to a single genetically linked population, variants of one biospecies. This phenomenon, which is quite common in boreal Triassic ammonoid faunas, has in the past led to serious taxonomic oversplitting. It presents a serious challenge to current ideas about a close correlation between modeof life and shell morphology in arnmonoids.□ Amntonoidea, boreal Triassic, ecology. Siberia, variability .     

Umbilical transposition in TRAM flap: a simple horizontal translocation

A simple method of umbilical repositioning by incising the anterior rectus sheath and rectus abdominis muscle is reported for cases of unilateral abdominal wall plication during the TRAM flap operation. This method keeps the umbilicus stable and nonstenotic, and it avoids hypertrophic scars, which result from other techniques such as direct suturing of the stalk to the skin. Although this method might weaken contralateral muscle activity, the patients we operated on maintained their ability to perform sit-ups, and no periumbilical weakening was noticed.     

Non-invasive genetic sampling for molecular sexing and microsatellite genotyping of hyacinth macaw (Anodorhynchus hyacinthinus)

Molted feather sampling is a useful tool for genetic analyses of endangered species, but it is often very laborious due to the low quality and quantity of the DNA obtained. In the present study we show the parts of feathers that resulted in better yield of DNA. In descending order these were: blood clot outside the umbilicus, umbilicus (without blood clot), tip, inner membrane, and small calamus. Compared to DNA extracted from blood samples, DNA extracted from feathers produced microsatellite alleles of poorer quality and had to be processed immediately after extraction. As expected due to the level of DNA degradation, molecular sexing protocols that result in shorter PCR products were more efficient.     

A simple technique for reconstruction of the umbilicus, using a conchal cartilage composite graft

A simple technique to reconstruct the umbilicus is reported in which a conchal cartilage composite graft, such as that used in tragus construction in the treatment of microtia, was employed with a very satisfactory result.     

Abdominoplasty and abdominal wall rehabilitation: a comprehensive approach

Standard abdominoplasty techniques involve a low horizontal or W skin excision, muscle plication, and umbilical transposition. Newer techniques include suction-assisted lipectomy, the use of high lateral tension with fascial suspension, and external oblique muscle advancement. The author has modified these traditional procedures and added new techniques to improve the aesthetic and functional results of the abdominoplasty procedure. This modification provides a comprehensive approach to abdominal wall aesthetic improvement and rehabilitation. The comprehensive approach described includes four components: the "U-M dermolipectomy," "V umbilicoplasty," the rectus abdominis "myofascial release," and suction-assisted lipectomy. The patient is marked while standing for areas of suction lipectomy and undermining. The lower incision is designed as an open U with the lateral limbs placed inside the bikini line. The upper incision is a lazy M with the higher peaks located at the level of the flanks. Subcutaneous hydration is achieved to perform suction along the flanks, waistline, and iliac areas. Gentle suction of the flaps is also performed. The umbilicus is cored out in a heart shape. The flaps within the U-M marks are excised, and the undermining is performed to the xiphoid and costal margins. The rectus diastasis is marked, and the anterior rectus fascia is incised at the junction of the medial third with the central third of the width of the rectus sheath. Horizontal figure-eight plication sutures by using the lateral fascial edge enable easier infolding of the central tissue. The new recipient of the umbilicus is made by an incision in a V shape on the abdominal flap. The umbilicus is telescoped, and the triangular flap of the abdomen is sutured to the triangular defect of the umbilicus. Skin flap fixation to the umbilicus relieves tension in the lower portion of the flap. The upper skin flap, which is cut in an M manner, provides lateral tension and matches the length of the lower flap. A standard fascial suspension is used and closure is performed in layers. The techniques described here are intertwined procedures. Each facilitates the accomplishment of the other procedure, and they complement each other. They all attain the 12 objectives of the abdominoplasty described. These combined techniques have been used in 104 patients in a period of 11 years. Complications were minimal and easily manageable, except for one patient who required excision of a pseudobursa and retightening of the lower quadrants of the abdominal wall musculature to correct extreme lordosis. A comprehensive approach for the treatment of complex abdominal wall aesthetic and functional defects is presented. These require thoughtful integration of the four components mentioned. This approach has allowed predictable, reproducible, and aesthetically pleasing results.     

血红素对人脐静脉内皮细胞氧化应激损伤的保护作用

采用过氧化氢作用于人脐静脉内皮细胞 ,成功地制作了氧化应激损伤的细胞模型 ,将培养的细胞分为 3组 :正常对照组 ,损伤组 (给予过氧化氢 )和血红素组 (同损伤组的制备 ,预先加入血红素 ) .观察各组细胞在光、电镜下形态学和蛋白质电泳的改变 ,用MTT法检测了各组细胞的生长状态 .结果表明 :在血红素组 ,细胞生长状态、MTT水平和蛋白质电泳结果与损伤组相比有明显好转且差异显著 ,证明血红素对人脐静脉内皮细胞氧化应激损伤有明显的保护作用 .     

Divergence in the shell morphology of the land snail genus Aegista (Pulmonata: Bradybaenidae) under phylogenetic constraints

The role of natural selection in phenotypic evolution is central to evolutionary biology. Phenotypic evolution is affected by various factors other than adaptation, and recent focus has been placed on the effects of phylogenetic constraints and niche conservatism on phenotypic evolution. Here, we investigate the relationship between the shell morphology and habitat use of bradybaenid land snails of the genus Aegista and clarify the causes of the divergence in shell morphology among phylogenetically related species. The results of ancestral state reconstruction showed that arboreal species have evolved independently from ground‐dwelling species at least four times. A significant association was found between shell shape and habitat use, despite the existence of a certain degree of phylogenetic constraint between these traits. A principal component analysis showed that arboreal species tend to have a relatively high‐spired shell with a narrow umbilicus. By contrast, ground‐dwelling species have a low‐spired shell with a wide umbilicus. Although the latitude and elevation of the sampling locations showed no relationship with shell morphology, the geology of the sampling locations affected the shell size of arboreal species. The development of a well‐balanced shell shape is one effective method for reducing the cost of locomotion under the force of gravity in each life habitat, resulting in the divergence in shell morphology and the independent evolution of morphologically similar species among different lineages. The present study suggests that ecological divergence is probably the cause of shell morphology divergence in land snails. © 2014 The Linnean Society of London, Biological Journal of the Linnean Society, 2014, 114 , 229–241.     

Acanthocephalan infection in man in northern Nigeria.

Acanthocephalan ova, indistinguishable from the ovoid eggs of Moniliformis moniliformis, were detected in the stools of a 45-year-old man at the University of Jos Health Clinic, Nigeria. The patient complained of general body weakness, occasional giddiness and intermittent burning sensations around the umbilicus. Successful treatment with niclosamide and the possible source of infection are communicated.     

A second locus for Rieger syndrome maps to chromosome 13q14.

Rieger syndrome is a genetically and phenotypically heterogeneous disorder typically characterized by malformations of the eyes, teeth, and umbilicus. The syndrome is inherited as an autosomal dominant trait and exhibits significant variable expressivity. One locus associated with this disorder has been mapped to 4q25. Using a large four-generation pedigree, we have identified a second locus for Rieger syndrome located on chromosome 13q14.     

A new species of hydrobiid snails (Mollusca, Gastropoda, Hydrobiidae) from central Greece

Anew minute valvatiform species belonging to the genus Daphniola Radoman, 1973, Daphniola eptalophossp. n., from mountain Parnassos, Greece is described. The new species has a transparent valvatiform-planispiral shell, wide and open umbilicus, grey-black pigmented soft body and head and a black penis with a small colorless outgrowth on the left side near its base. A comparative table of shell dimensions and a key to the species known for this endemic genus for Greece are provided.     

The Pleistocene glaciations and the evolutionary history of the polytypic snail species Arianta arbustorum (Gastropoda, Pulmonata, Helicidae)

The evolutionary history of the snail Arianta arbustorum is controversial. This diverse, polytypic species has two distinct forms: one, with a globular shell and closed umbilicus, is found from lowland to high altitudes; the other, with a depressed shell and open umbilicus, is found at a few scattered, high altitude localities. What is the origin of these two forms? Some believe that the depressed shell is a recent, local, ecotypic adaptation to alpine environments. Others believe that this form is a relic of an ancestral condition that may have survived the Pleistocene glaciations on nunatak-like montane refugia, while the globular shell is a derived condition and its presence at high altitudes follows post-Pleistocene recolonisation. We analysed a portion of the mitochondrial gene cytochrome oxidase I for 100 snails of the species A. arbustorum, three additional Arianta species, and nine outgroup taxa from five genera, in order to understand the phylogeographic history of the species. Despite some confounding artefacts that are likely due to introgression among the morphological forms, the resulting phylogeny shows that the depressed shell is plesiomorphic, while the globular shell is derived. Moreover, their disparate histories suggest that the depressed shell variety survived the glaciations in pockets of alpine refugia, while the globular shell variety recolonised the alpine environment post-glacially.     

Description of a new species of Calliostoma (Gastropoda,Calliostomatidae) from Southeastern?Brazil

Calliostoma tupinamba isa new species from Southeastern Brazil, ranging from southern Rio de Janeiro to northern São Paulo, and found only on coastal islands, on rocks and sessile invertebrates at 3 to 5 meters of depth. Shell and soft part morphology is described here in detail. Calliostoma tupinamba is mainly characterized by a depressed trochoid shell; eight slightly convex whorls; a sharply suprasutural carina starting on the third whorl and forming a peripheral rounded keel; and a whitish, funnel-shaped and deep umbilicus, measuring about 5%–10% of maximum shell width. Calliostoma tupinamba resembles Calliostoma bullisi Clench & Turner, 1960 in shape, but differs from it in being taller and wider, having a smaller umbilicus and lacking a strong and large innermost spiral cord at its base. Finally, an identification key of Brazilian Calliostoma species is presented.     

Umbilical blood flow and the effects of premature severance in the neonatal horse

Thirteen randomly assigned Quarter Horse foals were used in a study to determine the presence of umbilical blood flow immediately post partum and to determine if premature severance of the umbilical cord would alter significantly the hematology of the horse neonate. Packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), hemoglobin concentration (Hgb), red blood cell count (RBC), plasma protein (PP), and heart and respiratory rates were determined every 30 min for the first 6 h of life for both control and treated foals. Control foals had their umbilical cords measured for the presence of umbilical blood flow. Treated foals had their umbilical cords separated after birth and any free flow of blood collected and a volume measure determined. The umbilicus was separated within 10 sec post partum.No blood flow was detected in the control group of foals within 2 min post partum. The blood obtained from the separated umbilicus of the treatment group measured less than 125 cc. PCV, MCV, MCHC, Hgb, RBC, and PP were not significantly different between the two groups (P > 0.05). Except for MCHC and PP, all parameters studied decreased over the first 6 h of life. Heart rate and respiration rates did not significantly differ from each other (P > 0.05) and decreased over the first 6 h of life.     

Refinements in abdominoplasty with emphasis on reimplantation of the umbilicus

First, the author describes the suprapubic deepithelialized triangular flap to eliminate the dead space that can result when the abdominal flap, elevated from the periumbilical zone, meager in fatty tissue, is sutured to the thick pubic region. Second, because of the frequently poor quality of circular periumbilical scars, the author proposes a superiorly based, round-shaped flap taken from the future umbilical location and then defatted. The umbilical cylinder is divided vertically down to its aponeurotic attachment to permit insertion of this round skin flap, which is then anchored to the aponeurosis and to the edge of the triangular gap. This method prevents retracted periumbilical scars. Finally, in secondary corrections after abdominoplasty, satisfactory results can be obtained only if the umbilicus is detached from either the skin or the aponeurosis. The author's technique for covering the hole at the old umbilical location makes use of a round flap from the new umbilical site.