title: Perforator vessel anatomy of the papilla umbilicalis: topography and importance for reconstructive abdominal wall surgery.
abstract: OBJECTIVE
  Separation of midline abdominal wall components or other procedures involving the papilla umbilicalis within the context of abdominal wall reconstruction can significantly affect vasculature of the umbilicus. Adjusting dissection to the vascular anatomy of that region may evade such complications. For this purpose, an anatomic microdissection study was performed, focusing on the vascular architecture of the papilla umbilicalis in the midst of the stratigraphical anatomy of the midline abdominal wall.
  
  
  METHODS
  Ramifications of the epigastric vessels were filled with dye on 27 abdominal walls originating from 15 female and 12 male corpses. Vascular architecture of the midline abdominal wall was examined by X-ray imaging and microdissection focusing region of the papilla umbilicalis.
  
  
  RESULTS
  Vasculature of the papilla umbilicalis is provided by both myocutaneous and septocutaneous perforator vessels originating from the medial branch of the arteria epigastrica inferior and accompanying veins. On their way to the inferiolateral basis of the papilla umbilicalis, these perforators prove an intimate and regular association with the rectus abdominis muscle, and different components of the rectus sheath.
  
  
  CONCLUSIONS
  Vasculature of the papilla umbilicalis is susceptible to damage resulting from separation of midline abdominal wall components or periumbilical dissections. To secure vasculature of the papilla umbilicalis, the integrity of the loose areolar fascia covering the posterior surface of the rectus abdominis muscle must be kept from being harmed by dissection. In addition, the musculo-fibrous-aponeurotic anatomy on either the left or the right side of the papilla umbilicalis must be left in structural continuity.
authors.affiliation: Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. dodey@ukaachen.de
authors.forename: Dan mon
authors.initials: Dm
authors.lastname: O'Dey
authors.forename: Chukwubikem Akabogu
authors.initials: CA
authors.lastname: Okafor
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bozkurt
authors.forename: Andreas
authors.initials: A
authors.lastname: Prescher
authors.forename: Norbert
authors.initials: N
authors.lastname: Pallua
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D055806:Microvessels / Q000473:pathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D014472:Umbilicus / Q000098:blood supply*