Modified abdominoplasty for patients with the Prune Belly syndrome.
OBJECTIVE
To present the results of a new technique for abdominoplasty in patients with the Prune Belly syndrome (PBS).


METHODS
Since 1985, 46 children with PBS underwent surgical treatment that included urinary tract reconstruction (UTR), orchidopexy, and abdominoplasty. In 41 patients, we performed the abdominoplasty as follows: (1) fusiform longitudinal resection of the mid-abdominal skin and subcutaneous tissue, with preservation of the musculo-aponeurotic fascia (MAF) and umbilicus, (2) ellipsoid unilateral longitudinal incision of the MAF in the most weakened side of the abdomen, producing 2 flaps, with the umbilicus being kept intact in the widest flap, (3) after UTR and bilateral orchiopexy, suture fixation of the widest MAF layer to the inner side of the contralateral abdominal wall, creating an inner MAF layer, (4) lateral suture fixation of the other flap over the inner layer, creating an outer MAF layer with a buttonhole exposing the umbilicus, that is sutured to the outer layer, and (5) approximation of the skin edges with incorporation of the umbilicus in the suture.


RESULTS
Skin coaptation was excellent in all patients, and no trimming was necessary in incision extremities. There was no dehiscence or skin necrosis and all patients presented immediate improvement of the abdominal tonus and appearance. Further improvement with growth was observed in all except 4 patients, 2 requiring secondary abdominoplasties.


CONCLUSIONS
We conclude that this technique is applicable in all forms of weakened abdomen typical of PBS, even in asymmetrical cases, requiring only 1 MAF incision, with good cosmetic and functional results.
Division of Urology, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: ftdenes@gmail.com.
Francisco Tibor
FT
Dénes
Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.
Roberto Iglesias
RI
Lopes
Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.
Lorena Marçalo
LM
Oliveira
Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.
Alessandro
A
Tavares
Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.
Miguel
M
Srougi
D061645:Abdominoplasty / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D011535:Prune Belly Syndrome / Q000601:surgery*; D012189:Retrospective Studies