{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:27:18Z","timestamp":1787120838067,"version":"build-2736575974"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2005cm 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patients were 35\u201372 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1904266","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:45:08Z","timestamp":1787118308000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Four-point dermo-fascial fixation for umbilical reconstruction following keloid excision: clinical experience in 16 patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Peiyu","family":"Li","sequence":"first","affiliation":[{"name":"Department of Burn and Plastic Surgery, West China Hospital, Sichuan University","place":["Chengdu, Sichuan Province, China"]},{"name":"West China School of Medicine, Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitao","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Burn and Plastic Surgery, West China Hospital, Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuewen","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Burn and Plastic Surgery, West China Hospital, Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ru","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Burn and Plastic Surgery, West China Hospital, Sichuan University","place":["Chengdu, Sichuan Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"504","DOI":"10.23750\/abm.v90i4.7539","article-title":"Umbilical reconstruction: different techniques, a single aim","volume":"90","author":"Gardani","year":"2019","journal-title":"Acta Biomed"},{"key":"B2","doi-asserted-by":"publisher","first-page":"89","DOI":"10.53045\/jprs.2021-0034","article-title":"Excision of umbilical keloids after laparoscopic surgery and reconstruction by skin grafting: original research","volume":"2","author":"Tsujimoto","year":"2022","journal-title":"J Plast Reconstr Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"125","DOI":"10.14730\/aaps.2021.00101","article-title":"Umbilical trocar port site keloid management using a transposition flap after laparoscopic surgery","volume":"27","author":"Kwon","year":"2021","journal-title":"Arch Aesthetic Plast Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"78","DOI":"10.14730\/aaps.2024.01116","article-title":"Reconstruction of a deformed umbilicus with a keloid using a single triangular incision line: a case report","volume":"30","author":"Joo","year":"2024","journal-title":"Arch Aesthetic Plast Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1007\/s00266-016-0633-x","article-title":"Creating the perfect umbilicus: a systematic review of recent literature","volume":"40","author":"Joseph","year":"2016","journal-title":"Aesthetic Plast Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1111\/iwj.13920","article-title":"Laparoscopic procedures-induced keloids: a retrospective case series study","volume":"20","author":"Wang","year":"2023","journal-title":"Int Wound J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e5391","DOI":"10.1097\/GOX.0000000000005391","article-title":"Umbilical complications that require surgical intervention after gynecologic laparoscopic surgery","volume":"11","author":"Sano","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e3181","DOI":"10.1097\/GOX.0000000000003181","article-title":"Combination therapy composed of surgery, postoperative radiotherapy, and wound self-management for umbilical keloids","volume":"8","author":"Dohi","year":"2020","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"B9","first-page":"e8","article-title":"New method for umbilicoplasty with bilateral square flap and caudal deep inferior epigastric artery perforator flap","volume":"22","author":"Takaya","year":"2022","journal-title":"Eplasty"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.1007\/s12262-023-03876-z","article-title":"Creating a neo-umbilicus in abdominoplasty","volume":"85","author":"Kandulu","year":"2023","journal-title":"Indian J Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"730","DOI":"10.3390\/medicina57070730","article-title":"Adjuvant radiotherapy after surgical excision in keloids","volume":"57","author":"Lee","year":"2021","journal-title":"Medicina (B Aires)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e14449","DOI":"10.1111\/iwj.14449","article-title":"Comparison of surgical excision followed by adjuvant radiotherapy and laser combined with steroids for the treatment of keloids: a systematic review and meta-analysis","volume":"21","author":"Fu","year":"2024","journal-title":"Int Wound J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1007\/s00266-020-01860-6","article-title":"A comparison of aesthetic outcomes of umbilicoplasty in breast reconstruction with abdominal flap: inverted-U versus vertical oval incision","volume":"45","author":"Chung","year":"2021","journal-title":"Aesthetic Plast Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1177\/1090820X11430686","article-title":"The inverted-V chevron umbilicoplasty for breast reconstruction and abdominoplasty","volume":"32","author":"Lesavoy","year":"2012","journal-title":"Aesthet Surg J"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1904266\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:45:09Z","timestamp":1787118309000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1904266\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":14,"alternative-id":["10.3389\/fsurg.2026.1904266"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1904266","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"article-number":"1904266"}}