DIEP flaps in Women with Abdominal Scars: A Comparison of Complication Rates between Different Abdominal Incisions
Andres Doval, MD1, Lauren Daly, MD2, Bernard Lee, MD, MPH, MBA, FACS1, Arriyan S. Dowlatshahi, MD1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2University of Massachusetts, Worcester, MA, USA.
PURPOSE: There are still concerns that abdominal surgery can compromise an abdominally based perforator flap in microsurgical breast reconstruction. With this study, we take a closer look at the effect of prior abdominal incisions on Deep Inferior Epigastric Artery Perforator (DIEP) flap and donor site complications, with a particular focus on the different types of incisions and their influence on surgical outcomes.
METHODS: A retrospective case-control study was conducted over a 6-year period. 544 consecutive DIEP flaps were divided into a control group without previous abdominal surgery, and an incision group with previous abdominal surgery. A comparison between both groups was made in terms of flap and donor site complications, followed a sub-group analysis based on the type of abdominal incision.
RESULTS: 223 flaps were included in the incision group and 321 in the control group. There were no significant differences between groups in terms of age, flap weight, smoking history, prior radiation history and comorbidities. We found a higher BMI in the incision group (p=0.01). There were no significant differences between the control group and the incision group in terms of flap complications (complete flap loss, partial flap loss and fat necrosis). However, donor site complications, specifically wound separation was found to occur at a higher incidence in the incision group (p=0.0001). In the sub-group analysis, patients with a low transverse incision had higher rates of fat necrosis (8.0% vs 23% p=0.0001) and donor site wound separation (9.0% vs 23% p=0.002). No statistically significant differences were found between patients in the control group and those with laparoscopic incisions on the one hand, and those with a combination of laparoscopic and low transverse incision on the other.
CONCLUSION: The results from this large series of consecutive DIEP flaps from our institution confirms that autologous breast reconstruction with a DIEP flap can be safety performed in patients who have had previous abdominal surgeries; however, patients must be made aware of the increased risk of donor site complications.
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