Four-point dermo-fascial fixation for umbilical reconstruction following keloid excision: clinical experience in 16 patients.

BACKGROUND

Umbilical keloids after transumbilical laparoscopic surgery are difficult to manage because excision may leave a contour defect in a concave, mobile, and scar-prone region. Reconstruction must restore a recessed umbilical contour while minimizing additional incisions and scar burden.

METHODS

This brief report describes a four-point dermo-fascial fixation technique in 16 patients with round, bulging, or transversely elongated umbilical keloids after laparoscopic surgery. In all patients, the keloid margin extended no more than 1.0 cm beyond the visible umbilical rim. After limited circumferential defatting, adjacent umbilical tissue was anchored to the residual fibrous umbilical stalk and linea alba using a four-point configuration. All patients received postoperative radiotherapy and topical scar therapy.

RESULTS

The patients were 35-72 years old, and photographic follow-up ranged from 6 to 15 months. All patients maintained a recessed umbilical contour during the available follow-up. No wound complications were observed, and no clinically evident keloid recurrence occurred after combined surgical reconstruction, postoperative radiotherapy, and topical scar therapy. A transverse scar or crease remained visible in some cases.

CONCLUSION

The four-point dermo-fascial fixation technique may provide a simple local-tissue option for scar-control-oriented umbilical reconstruction after keloid excision, although it should not be considered an ideal aesthetic umbilicoplasty. Its main value lies in its simplicity, use of adjacent local tissue, avoidance of graft harvest or complex flap design, and potential reproducibility when scar control and technical practicality are prioritized. Larger studies with longer follow-up and standardized scar assessment are required to clarify long-term recurrence and aesthetic outcomes.