Spiral rotational flap for the creation of a new umbilicus in bladder exstrophy.
OBJECTIVE
A range of surgical techniques have been described to create a new umbilicus in children with bladder exstrophy. We present a detailed video demonstrating our technique for the creation of a new umbilicus.


METHOD
The position of the planned umbilicus and flap were marked on the abdomen. Incisions were made using monopolar diathermy. The flap was raised and excess fat thinned. Subcutaneous tissues were apposed, and the flap rotated and sutured in spiral fashion with interrupted 6/0 monocryl forming a cone which was subsequently inverted.


RESULTS
Between May 1999 and August 2014, we used this technique for the creation of a new umbilicus in 47 bladder exstrophy patients (31 boys and 16 girls). No complications occurred. All were followed up as part of our bladder exstrophy programme.


CONCLUSION
The technique allows reproducible excellent cosmetic results. Aesthetic results are durable and it should be considered as an alternative to existing reported techniques.