Deep Inferior Epigastric Perforator (DIEP) Flap for Vulvar Reconstruction After Radical Vulvectomy

2005 ◽  
Vol 55 (4) ◽  
pp. 427-429 ◽  
Author(s):  
Gan Muneuchi ◽  
Masayuki Ohno ◽  
Atsuko Shiota ◽  
Toshiyuki Hata ◽  
Hiroharu H. Igawa
Keyword(s):  
Diep Flap ◽  
Vulvar Reconstruction ◽  
Deep Inferior Epigastric Perforator ◽  
Radical Vulvectomy

scholarly journals The Pedicled Deep Inferior Epigastric Perforator (DIEP) Flap for Vulva Reconstruction

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Bachleitner K ◽  
◽  
Ndhlovu M ◽  
Schoeller T ◽  
Amr A ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acne Inversa ◽  
Diep Flap ◽  
Scar Contracture ◽  
Functional Reconstruction ◽  
Labia Majora ◽  
Vulvar Reconstruction ◽  
Deep Inferior Epigastric Perforator ◽  
Tissue Restoration ◽  
Tissue Defects

Pain, scar contracture and soft tissue defects are common late sequel of acne inversa and Fournier’s gangrene. Aesthetical as well as functional reconstruction of the external vulva and labia majora can be very challenging. We present two cases where a pedicled Deep Inferior Epigastric Perforator (DIEP) flap for vulva reconstruction was implemented. In order to reconstruct both labia majora, we partially split the flap and raised a bilaterally pedicled DIEP flap. Many local flap techniques have been published on vulvar reconstruction. The aim of this paper is a discussion of the present literature and a review of current strategies for soft tissue restoration with the DIEP flap for vulva reconstruction. Wepresent and discuss two cases which were successfully reconstructed using the described surgical technique

Vulvar Reconstruction by Perforator Flaps: Algorithm for Flap Choice Based on the Topography of the Defect

2015 ◽  
Vol 25 (7) ◽  
pp. 1322-1327 ◽  
Author(s):  
Luca Negosanti ◽  
Rossella Sgarzani ◽  
Erich Fabbri ◽  
Stefano Palo ◽  
Carlo Maria Oranges ◽  
...  
Keyword(s):  
Diep Flap ◽  
Type I ◽  
Type Ii ◽  
Perforator Flaps ◽  
Vulvar Reconstruction ◽  
Type Ia ◽  
Deep Inferior Epigastric Perforator ◽  
Reconstructive Algorithm ◽  
Lotus Petal Flap

ObjectiveMany techniques have been proposed to reconstruct acquired vulvar defects. In our experience, every type of vulvar defect can be repaired with 2 pedicled flaps, namely, the pedicle deep inferior epigastric perforator (DIEP) flap and the lotus petal flap (LPF).Materials and MethodsWe report our reconstructive algorithm for vulvar reconstruction, based on the topography of the defect, applied in 22 consecutive patients from 2000 to 2012. According to the proposed algorithm, DIEP flap and LPF (monolateral or bilateral type) can repair all kinds of wide vulvar defects. Surgical defects were classified as type I (IA and IB) and type II in relation to the anatomy of the defect.ResultsNo major complications were reported in our series. All patients reported satisfactory results, both functionally and aesthetically.ConclusionsWe propose an easy classification of acquired vulvar defects separating the ones consequent only to the vulvar resection, with preservation of vagina (type I), by the wider defects after vaginal and vulvar resection (type II); type I can be subclassified into defects consequent to half-vulvar resection (type IA) or to total vulvar resection (type IB). Type I defects (IA and IB) can be reconstructed with monolateral or bilateral LPF; in type II resections, we have a great wound that required more tissue to fill the pelvic dead space, so we prefer pedicle DIEP flap.

The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients

2021 ◽  
Author(s):  
Taehee Jo ◽  
Dong Nyeok Jeon ◽  
Hyun Ho Han
Keyword(s):  
Donor Site ◽  
Wound Dehiscence ◽  
Diep Flap ◽  
Separate Analysis ◽  
Flap Reconstruction ◽  
Average Body Mass Index ◽  
Deep Inferior Epigastric Perforator ◽  
Average Body Mass ◽  
Artery Perforator ◽  
Average Body

Abstract Background The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated. Methods Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. PAP flap breast reconstructions were compared with standard deep inferior epigastric perforator (DIEP) flap breast reconstructions, and were grouped into single or stacked PAP flaps for further analysis. Results Overall, 43 PAP flaps were performed to reconstruct 32 breasts. Eleven patients underwent stacked PAP flap reconstruction, while 17 patients underwent 21 single PAP flap reconstruction. The average body mass index (BMI) of the patients was 22.2 ± 0.5 kg/m2. The results were as follows: no total loss, one case of venous congestion (2.3%), two donor site wound dehiscence cases (4.7%), and one case of fat necrosis from partial flap loss (2.3%). When compared with 192 DIEP flap reconstructions, the final DIEP flap supplied 98.1 ± 1.7% of mastectomy weight, while the final PAP flap supplied 114.1 ± 6.2% of mastectomy weight (p < 0.005), demonstrating that PAP flaps can successfully supply final reconstruction volume. In a separate analysis, single PAP flaps successfully supplied 104.2% (84.2-144.4%) of mastectomy weights, while stacked PAP flaps supplied 103.7% (98.8-115.2%) of mastectomy weights. Conclusion In our series of PAP flap reconstructions performed in low-to-normal BMI patients, we found that PAP flaps, as single or stacked flaps, provide sufficient volume to reconstruct mastectomy defects.

Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction

2021 ◽  
Author(s):  
Nicholas T. Haddock ◽  
Ricardo Garza ◽  
Carolyn E. Boyle ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Compliance Rate ◽  
Fluid Management ◽  
Control Group ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Eras Protocol

Abstract Background The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution. Methods This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance. Results Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time. Conclusion The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.

scholarly journals Refractory Donor-Site Seroma Following DIEP Breast Reconstruction

2020 ◽  
Vol 6 ◽  
pp. 2513826X1989883
Author(s):  
Trina V. Stephens ◽  
Nancy Van Laeken ◽  
Sheina A. Macadam
Keyword(s):  
Literature Review ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Diep Flap ◽  
First Line ◽  
Percutaneous Aspiration ◽  
Autologous Breast Reconstruction ◽  
History Of ◽  
Deep Inferior Epigastric Perforator ◽  
Latissimus Dorsi Flaps

Donor-site seroma formation is a complication of autologous breast reconstruction reported most commonly with the use of latissimus dorsi flaps. First-line treatment is percutaneous aspiration which leads to resolution in the majority of cases. Those that persist may progress to a chronic, refractory seroma, which can prove challenging in terms of treatment. The aim of this article is to provide an updated literature review of interventions for chronic donor-site seroma and present the case of a 65-year-old female with a recalcitrant abdominal seroma following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Literature review revealed a single article that reported 2 cases of persistent donor-site seroma after DIEP flap breast reconstruction. The patient presented here underwent repeat aspiration, drain placement, and multiple surgical procedures to achieve resolution. In total, the post-reconstruction seroma history of the patient extended over approximately 14 months. We conclude with evidence-based suggestions for chronic, donor-site seroma prevention and treatment.

Sign in / Sign up

Export Citation Format

Share Document