90. Neurotisation in deep inferior epigastric artery perforator (DIEP) flap breast reconstructions: Our technique and results

As deep inferior epigastric artery perforator (DIEP) flap surgery is gaining popularity, more patients including BRCA-positive patients need simultaneous laparoscopic surgery. We share our experience on a patient who underwent concurrent laparoscopic hysterectomy during flap elevation with a novel method. A patient diagnosed with a right breast cancer also required laparoscopic hysterectomy due to multiple uterine myoma. After perforator mapping was performed, flap elevation through external oblique fascia level was carried out first, sparing the periumbilical perforator and superficial inferior epigastric vein. Three ports were inserted for laparoscopy on posterior fascia level in the periumbilical area, left upper quadrant area and suprapubic area. The surgery was completed without any complication, gas leaks or vascular injury with the advantage of reduced risk of vascular damage and less surgical incision.

Download Full-text

Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

Archives of Plastic Surgery ◽

10.5999/aps.2019.01417 ◽

2020 ◽

Vol 47 (4) ◽

pp. 324-332

Author(s):

Alexander A. Azizi ◽

Anita T. Mohan ◽

Taj Tomouk ◽

Elizabeth B. Brickley ◽

Charles M. Malata

Keyword(s):

Postoperative Pain ◽

Breast Reconstruction ◽

Hospital Stay ◽

Diep Flap ◽

Inferior Epigastric Artery ◽

Epigastric Artery ◽

Significant Difference ◽

Deep Inferior Epigastric Artery ◽

Postoperative Morphine ◽

Artery Perforator

Background The deep inferior epigastric artery perforator (DIEP) flap is the commonest flap used for breast reconstruction after mastectomy. It is performed as a unilateral (based on one [unipedicled] or two [bipedicled] vascular pedicles) or bilateral procedure following unilateral or bilateral mastectomies. No previous studies have comprehensively analyzed analgesia requirements and hospital stay of these three forms of surgical reconstruction.Methods A 7-year retrospective cohort study (2008–2015) of a single-surgeon’s DIEP-patients was conducted. Patient-reported pain scores, patient-controlled morphine requirements and recovery times were compared using non-parametric statistics and multivariable regression.Results The study included 135 participants: unilateral unipedicled (n=84), unilateral bipedicled (n=24) and bilateral unipedicled (n=27). Univariate comparison of the three DIEP types showed a significant difference in 12-hour postoperative morphine requirements (P=0.020); bipedicled unilateral patients used significantly less morphine than unipedicled (unilateral) patients at 12 (P=0.005), 24 (P=0.020), and 48 (P=0.046) hours. Multivariable regression comparing these two groups revealed that both reconstruction type and smoking status were significant predictors for 12-hour postoperative morphine usage (P=0.038 and P=0.049, respectively), but only smoking, remained significant at 24 (P=0.010) and 48 (P=0.010) hours. Bilateral reconstruction patients’ mean hospital stay was 2 days longer than either unilateral reconstruction (P<0.001).Conclusions Although all three forms of DIEP flap breast reconstruction had similar postoperative pain measures, a novel finding of our study was that bipedicled DIEP flap harvest might be associated with lower early postoperative morphine requirements. Bilateral and bipedicled procedures in appropriate patients might therefore be undertaken without significantly increased pain/morbidity compared to unilateral unipedicled reconstructions.

Download Full-text

Our early experience in immediate total breast reconstruction with deep inferior epigastric artery perforator flap

International Surgery Journal ◽

10.18203/2349-2902.isj20195410 ◽

2019 ◽

Vol 6 (12) ◽

pp. 4444

Author(s):

Thyagaraj . ◽

Ashrith Iyanahally ◽

B. G. Tilak ◽

M. E. Sham ◽

Ganesh .

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Breast Cancer Diagnosis ◽

Donor Site Morbidity ◽

Diep Flap ◽

Inferior Epigastric Artery ◽

Aesthetic Result ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Artery Perforator

Background: As the breast cancer diagnosis has increased over recent years, patient have become more informative regarding treatment and reconstructive options, hence the expectation of the results will be very high. Reconstruction of breast with best result and less donor site morbidity is the target.Methods: A total of 20 cases were studied between January 2018 to January 2019 at our hospital to assess the outcome of deep inferior epigastric artery perforator (DIEP) flap for immediate breast reconstruction.Results: A total of twenty DIEP flaps were performed. Mean time required for flap harvest was 125 minutes, and time taken for flap inset was 110 minutes. There was no flap loss in any of the twenty cases. Two patients had fat necrosis. All patients were satisfied with aesthetic outcome.Conclusions: DIEP flap has good aesthetic result with less donor site morbidity.

Download Full-text

A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap

American Journal of Case Reports ◽

10.12659/ajcr.905671 ◽

2017 ◽

Vol 18 ◽

pp. 1284-1288 ◽

Cited By ~ 1

Author(s):

Sara Di Lorenzo ◽

Giovanni Zabbia ◽

Bartolo Corradino ◽

Massimiliano Tripoli ◽

Roberto Pirrello ◽

...

Keyword(s):

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Rare Case ◽

Diep Flap ◽

Inferior Epigastric Artery ◽

Immediate Reconstruction ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Artery Perforator ◽

Giant Basal Cell Carcinoma

Download Full-text

Perforator Mapping Practice for Deep Inferior Epigastric Artery Perforator Flap Reconstructions: A Survey of the Benelux Region

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1714427 ◽

2020 ◽

Author(s):

Vivian B. Boer ◽

Jan J. van Wingerden ◽

Carolien F. Wever ◽

Michiel R. Beets ◽

Pauline D. Verhaegen ◽

...

Keyword(s):

Imaging Modality ◽

Perforator Flap ◽

Routine Practice ◽

Diep Flap ◽

Inferior Epigastric Artery ◽

Advantages And Disadvantages ◽

Epigastric Artery ◽

Surgeon Experience ◽

Deep Inferior Epigastric Artery ◽

Artery Perforator

Abstract Background Numerous new and novel imaging techniques for preoperative perforator selection in deep inferior epigastric artery perforator (DIEP) flap planning have been introduced. To what extent, these have been adopted into or replaced routine practice has hitherto remained unknown. The purpose of this study was to identify the currently preferred technique by reconstructive surgeons, the criteria that they regard as most relevant and what impact these have on the preoperative decision-making. Methods An online survey consisting of 25 questions was sent to members of the Benelux Societies for Plastic Surgery. Information regarding experience and preferred imaging modality was requested. Specific questions addressed the utilization of computed tomography angiography (CTA) and factors that could inform preoperative perforator selection. Results were anonymously collected, managed using REDCap, and analyzed using Chi-square statistic. Results Seventy-nine principal surgeons could be included. A variation in surgeon experience was observed. On CTA, the preferred imaging modality, large-caliber vessels, the location of the perforator in the flap, and its intramuscular course were considered the most significant criteria. Surgeons doing more than 20 DIEP flaps per year are less concerned about the distance of the perforator from the umbilicus (p = 0.003) but more likely to choose a medial perforator (p = 0.011). No statistical difference was found in surgeons' experience between those who would choose and use one specific (medial or lateral) perforator when they are analogous on CTA, and those who would delay the decision until both perforators have been exposed. Conclusion Advantages and disadvantages of the current practice of preoperative perforator selection by surgeons who are primarily responsible for harvesting a DIEP flap have been clearly identified. Indications are that these could be widely representative in which case, the quest for a protocol or modality that maximizes the benefit and minimizes harm in preoperative perforator mapping is urgently required.

Download Full-text

Effects of venous supercharging in deep inferior epigastric artery perforator flap

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502007000600011 ◽

2007 ◽

Vol 22 (6) ◽

pp. 474-478 ◽

Cited By ~ 6

Author(s):

Anne Karoline Groth ◽

Antônio Carlos Ligocki Campos ◽

Carolina Gomes Gonçalves ◽

Ruy Fernando Caetano da Silva ◽

Alfredo Benjamim Duarte da Silva ◽

...

Keyword(s):

Perforator Flap ◽

Control Group ◽

Diep Flap ◽

Inferior Epigastric Artery ◽

Doppler Flowmetry ◽

Flap Survival ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Deep Inferior Epigastric Perforator ◽

Artery Perforator

PURPOSE: To evaluate the effects of venous supercharging in deep inferior epigastric artery perforator flap in rats. METHODS: 20 Wistar rats were randomized in 2 groups: control group (C), all had flaps raised based on the deep inferior epigastric perforator vessels (DIEP), and experimental group (E), which was identical to group C, except that the contralateral superficial inferior epigastric vein was also kept with the flap. Flow studies using laser Doppler flowmetry where performed daily in the four zones of the flap. On the 7th postoperative day rats were killed and flap survival was determined using digital planimetry. RESULTS: Flow values were presented as a percentage of the baseline flow after incision of the flap edges. The surviving flap area was demonstrated as a percentage of the total flap area. Evaluation by digital planimetry showed that flap survival in group E was higher than in group C (97,38%±1,32%vs.44,13%±4,83%, p=0,0006). CONCLUSION: This study shows that venous supercharging of the rat DIEP flap results in greater flap survival.

Download Full-text