Survival of umbilicus on a superiorly based flap after fleur-de-lis abdominoplasty A case report

Introduction: Massive weight loss patients have a midline excess of abdominal adipose and skin tissue that contributes to an increased abdominal girth. This excess of tissue in these patients is not resolved with traditional techniques of abdominoplasty and usually the fleur-de-lis abdominoplasty technique is employed. Patient concerns: A 22-year-old male patient came to our clinic after a massive weight loss of 170 kg, requesting an abdominoplasty for the excess adipose and skin tissue. Diagnosis: Massive weight loss patient, with excess of adipose and skin tissue in the midline abdominal area. Interventions: Fleur-de-lis abdominoplasty technique was employed for treatment of massive weight loss. Outcomes: During the surgery, it was decided that the umbilicus blood supply via the inferior epigastric artery and median umbilical ligament needed to be ligated, to remove more tissue for better aesthetic result. The umbilicus survived on the collateral blood supply from ligamentum teres and superior epigastric collaterals. Conclusion/Lessons: In this case report we review our experience treating a massive weight loss patient using a fleur-de-lis abdominoplasty technique without preserving the umbilicus blood supply via the inferior epigastric artery and median umbilical ligament. We eventually relied on the collateral blood supply from ligamentum teres and superior epigastric collaterals, something that proved advantageous both in the survival of the umbilicus on the long run despite cutting off the main blood supply, and, the removal of further excess adipocutaneous tissue for a better aesthetic outcome.