No-drain DIEP Flap Donor-site Closure Using Barbed Progressive Tension Sutures

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.

Download Full-text

How Do We Raise the Bar in Autologous Breast Reconstruction? The Use of Progressive Tension Sutures for Donor Site Closure

Plastic & Reconstructive Surgery Global Open ◽

10.1097/01.gox.0000584316.54908.08 ◽

2019 ◽

Vol 7 ◽

pp. 22-23

Author(s):

Kristy L. Hamilton ◽

Andres F. Doval ◽

Kieran S. Boochoon ◽

Aldona J. Spiegel

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Autologous Breast Reconstruction ◽

Progressive Tension Sutures

Download Full-text

Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1727202 ◽

2021 ◽

Author(s):

Charles W. Patterson ◽

Patrick A. Palines ◽

Matthew J. Bartow ◽

Daniel J. Womac ◽

Jamie C. Zampell ◽

...

Keyword(s):

Breast Reconstruction ◽

Full Range ◽

Donor Site ◽

World Health ◽

Morbidly Obese ◽

Diep Flap ◽

Obese Patients ◽

Class Iii ◽

Recipient Site ◽

Surgical Risk

Abstract Background From both a medical and surgical perspective, obese breast cancer patients are considered to possess higher risk when undergoing autologous breast reconstruction relative to nonobese patients. However, few studies have evaluated the continuum of risk across the full range of obesity. This study sought to compare surgical risk between the three World Health Organization (WHO) classes of obesity in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods A retrospective review of 219 obese patients receiving 306 individual DIEP flaps was performed. Subjects were stratified into WHO obesity classes I (body mass index [BMI]: 30–34), II (BMI: 35–39), and III (BMI: ≥ 40) and assessed for risk factors and postoperative donor and recipient site complications. Results When examined together, the rate of any complication between the three groups only trended toward significance (p = 0.07), and there were no significant differences among rates of specific individual complications. However, logistic regression analysis showed that class III obesity was an independent risk factor for both flap (odds ratio [OR]: 1.71, 95% confidence interval [CI]: 0.91–3.20, p = 0.03) and donor site (OR: 2.34, 95% CI: 1.09–5.05, p = 0.03) complications. Conclusion DIEP breast reconstruction in the obese patient is more complex for both the patient and the surgeon. Although not a contraindication to undergoing surgery, obese patients should be diligently counseled regarding potential complications and undergo preoperative optimization of health parameters. Morbidly obese (class III) patients should be approached with additional caution, and perhaps even delay major reconstruction until specific BMI goals are met.

Download Full-text

Refractory Donor-Site Seroma Following DIEP Breast Reconstruction

Plastic Surgery Case Studies ◽

10.1177/2513826x19898831 ◽

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.

Download Full-text

Alternative flaps for microsurgical breast reconstruction

10.1093/med/9780199682874.003.0093 ◽

2021 ◽

pp. 1107-1114

Author(s):

Hinne A. Rakhorst

Keyword(s):

Breast Reconstruction ◽

Standard Care ◽

Donor Site ◽

Perforator Flap ◽

Donor Site Morbidity ◽

The Body ◽

Diep Flap ◽

Deep Inferior Epigastric Perforator ◽

Muscle Sparing ◽

Breast Reconstructive Surgery

Microsurgery in general has made dramatic improvements over the past decades. This applies to microsurgery in general and to breast reconstructive surgery especially. The demand for autologous breast reconstruction has risen. Since the introduction of the free transverse rectus abdominis myocutaneous (TRAM) flaps, through the muscle-sparing TRAM, flaps designs have evolved into the current gold standard, the deep inferior epigastric perforator (DIEP) flap. From experiences and increasing numbers of flap procedures performed by surgeons, techniques became more familiar and part of standard care. These factors gave rise to the development of a growing number of areas of the body where tissues of interest can be harvested using perforator flap-based techniques. This chapter discusses the most common as well as the ‘rising stars’ in terms of flaps to be used as alternative flaps to the DIEP flap for breast reconstruction. It discusses practical issues on dissection as well as donor site morbidity.

Download Full-text

How Does Autologous Breast Reconstruction Impact Downtime?

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1641711 ◽

2018 ◽

Vol 34 (07) ◽

pp. 530-536 ◽

Cited By ~ 3

Author(s):

Daniel Rais ◽

Jian Farhadi ◽

Giovanni Zoccali

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Diep Flap ◽

Autologous Reconstruction ◽

Autologous Breast Reconstruction ◽

Superior Gluteal Artery ◽

Free Flap Surgery ◽

Recovery Times ◽

Time Required ◽

The Impact

Background Although autologous breast reconstruction is technically quite demanding, it offers the best outcomes in terms of durable results, patient perceptions, and postoperative pain. Many studies have focused on clinical outcomes and technical aspects of such procedures, but few have addressed the impact of various flaps on patient recovery times. This particular investigation entailed an assessment of commonly used flaps, examining the periods of time required to resume daily activities. Methods Multiple choice questionnaires were administered to 121 patients after recovery from autologous reconstruction to determine the times required in returning to specific physical activities. To analyze results, the analysis of variance F-test was applied, and odds ratios (ORs) were determined. Results Among the activities surveyed, recovery time was not always a function of free-flap surgery. Additional treatments and psychological effects also contributed. Adjuvant chemotherapy increased average downtime by 2 weeks, and postoperative irradiation prolonged recovery as much as 4 weeks. Patient downtime was unrelated to flap type, ranging from 2.9 to 21.3 weeks for various activities in question. Deep inferior epigastric perforator (DIEP) flaps yielded the highest OR and transverse upper gracilis (TUG) flaps the lowest. Conclusion Compared with superior gluteal artery perforator and TUG flaps, the DIEP flap was confirmed as the gold standard in autologous breast reconstruction, conferring the shortest recovery times. All adjuvant therapies served to prolong patient recovery as well. Surgical issues, patient lifestyles, and donor-site availability are other important aspects of flap selection.

Download Full-text