Epidermal Inclusion Cyst of the Umbilicus Following Abdominoplasty
Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, USA.Plastic surgical nursing: official journal of the American Society of Plastic and Reconstructive Surgical Nurses 10/2007; 27(4):202-5. DOI: 10.1097/01.PSN.0000306186.72942.ae
The incidence of retained epidermal inclusion cyst at the site of the umbilicus following abdominoplasty has yet to be well documented. Compliant patients who are seen in scheduled follow-up, and who display signs of infection or wound issues at the site of the umbilicus, usually have these factors addressed before inclusion cysts manifest. Here, however, we present a patient who underwent abdominoplasty, lost her surgeon because of geographic relocation, presented to our office 1 year following surgery with a large retained umbilical epidermal inclusion cyst. This case gave us a unique opportunity to observe a well-developed retained umbilical epidermal inclusion cyst. Her evaluation and management are reviewed in an effort to familiarize the practicing plastic surgeon with a rare, but significant potential complication of abdominoplasty.
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ABSTRACT: A retained epidermal inclusion cyst (REIC) at the umbilicus after abdominoplasty is a rare phenomenon that has had limited description in the literature. This case report describes a woman who came for a secondary abdominoplasty and presented intraoperatively with an unexpected large epidermal inclusion cyst. The woman was disappointed with the result of a previous abdominal surgery. She initially had severe postoperative wound infection followed by revision surgery and subsequent intermittent secretion in the umbilical region. Then seven years later, hip backplasty combined with liposuction was performed. After another six months, full abdominoplasty combined with exploration of the umbilical region was performed. The surgical exploration showed a large, 3×4.5 cm indurated structure highly suspected to be a REIC. The excision was effective without recurrence, and the healing was uneventful. The patient was very satisfied with the result. As a typical epidermoid cyst, REIC consists of squamosed stratified epithelial cells that continue to the granular layer. In most cases, the cyst is filled with a keratin-like material. When this tumor is solid, a histologic evaluation may be necessary. When the cyst has been excised, the umbilicus gets reconstructed after the abdominoplasty. A history of poor healing in the umbilicus area may arouse suspicion of an epidermoid cyst. Epidermoid cysts in the region of the umbilicus could easily be overlooked in preparation of the umbilicus.
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ABSTRACT: The umbilicus is viewed as a portal by the laparoscopic surgeon, a doorway to the real business at hand. However, the umbilicus itself may be the site of a variety of lesional conditions. Some of these may be iatrogenic, caused by prior surgical interventions, such as endometriosis or seeding of a malignant neoplasm. Some may be the initial presenting complaint. This review discusses umbilical lesions that may be encountered by the minimally invasive gynecologic surgeon. Journal of Minimally Invasive Gynecology (2012) 19, 680-683
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