The arterial vascularisation of the abdominal wall with special regard to the umbilicus

Aim. In order to prevent wound healing problems around the transposed umbilicus following abdominoplasty, we investigated the arterial vascularisation of the abdominal wall with special regard to the umbilicus. The aim was to optimise the planning of the umbilical stalk and flap design. Method. The inferior and superior epigastric arteries of 12 cadavers (mean age 83 years) were injected with barium-sulphate, lead-mennige and gelatine. The abdominal walls were resected en bloc and X-ray photographs were taken by conventional and mammographic technique. Results. The radiographic examination showed that the main trunks of the epigastric vessels follow an ‘hour-glass’ or ‘rhomboid’ pattern around the centromedial umbilicus. Each main trunk splits into two obligate branches one medial and one lateral. The anastomosis between the inferior and superior epigastric artery is located above the umbilicus. The umbilicus is nourished by separate axial vessels originating from the inferior epigastric artery. It was also shown that the inferior intercostal arteries anastomose with the branches of the inferior and superior epigastric artery. Conclusion. Dividing the abdominal wall into four quadrants around the central umbilicus, the lateral areas of the lower quadrants show the weakest vascularisation by the inferior epigastric artery. This fact may cause healing problems after surgery in this area. The axial vascularisation of the umbilicus makes any torsion or traction a potential hazard to the umbilical flap during abdominoplasty especially by re-siting the umbilicus. The anatomical study showed clearly the benefit of preparing a broad base fat layer with a generous diameter of incision line around the umbilicus.