TY - JOUR
T1 - Evaluation of the single medial circummuscular perforator DIEP flap
T2 - Outcomes and comparison to traditional transmuscular single perforator flap
AU - Rose, Jessica F.
AU - Zavlin, Dmitry
AU - Garrett, Amanda E.
AU - Chegireddy, Vishwanath
AU - Ellsworth, Warren A.
N1 - Publisher Copyright:
© 2017 Wiley Periodicals, Inc.
PY - 2018/7
Y1 - 2018/7
N2 - Introduction: Successful breast reconstruction using deep inferior epigastric perforator (DIEP) flaps depends on optimal perforator choice. Circummuscular wraparound medial perforators allow for no rectus dissection and minimal fascial incisions, often presenting as an ideal option. The aim of our study is to evaluate outcomes of the single medial wraparound perforator flap in comparison to more traditional transmuscular single-perforator DIEP flaps. Patients and methods: A retrospective chart review was conducted of all DIEP flaps performed by the senior author from 2011 to 2016, yielding 269 flaps on 157 patients. For this study, we included all patients who underwent reconstruction of the breast(s) and possessed circummuscular perforators arising from the DIE vessels. A control group consisted of all consecutive patients with transmuscular one-perforator DIEP flaps. Patient details and their postoperative outcomes were collected. Results: In our study, eight patients (5.1%) were of the medial wraparound variety. Sixteen control patients (10.2%) with similar comorbidities had flaps that were of the more traditional single perforator transmuscular variety. There was a slight trend toward decreased operative time in the medial wraparound group, however, it was not found to be statistically significant (536 ± 81 vs. 572 ± 84 min, P =.377). Complication profiles were similar between groups (25.0 vs. 18.8%, P =.722), with no increased rates of fat necrosis in the wraparound cohort. Conclusion: Based on our findings, using a medial wraparound perforator is a safe and reliable option when compared with a single transmuscular perforator DIEP flap. Choosing the wraparound perforator may show benefit as it eliminates muscular dissection and nerve damage, and tends to minimize fascial incision length.
AB - Introduction: Successful breast reconstruction using deep inferior epigastric perforator (DIEP) flaps depends on optimal perforator choice. Circummuscular wraparound medial perforators allow for no rectus dissection and minimal fascial incisions, often presenting as an ideal option. The aim of our study is to evaluate outcomes of the single medial wraparound perforator flap in comparison to more traditional transmuscular single-perforator DIEP flaps. Patients and methods: A retrospective chart review was conducted of all DIEP flaps performed by the senior author from 2011 to 2016, yielding 269 flaps on 157 patients. For this study, we included all patients who underwent reconstruction of the breast(s) and possessed circummuscular perforators arising from the DIE vessels. A control group consisted of all consecutive patients with transmuscular one-perforator DIEP flaps. Patient details and their postoperative outcomes were collected. Results: In our study, eight patients (5.1%) were of the medial wraparound variety. Sixteen control patients (10.2%) with similar comorbidities had flaps that were of the more traditional single perforator transmuscular variety. There was a slight trend toward decreased operative time in the medial wraparound group, however, it was not found to be statistically significant (536 ± 81 vs. 572 ± 84 min, P =.377). Complication profiles were similar between groups (25.0 vs. 18.8%, P =.722), with no increased rates of fat necrosis in the wraparound cohort. Conclusion: Based on our findings, using a medial wraparound perforator is a safe and reliable option when compared with a single transmuscular perforator DIEP flap. Choosing the wraparound perforator may show benefit as it eliminates muscular dissection and nerve damage, and tends to minimize fascial incision length.
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U2 - 10.1002/micr.30273
DO - 10.1002/micr.30273
M3 - Article
C2 - 29193255
AN - SCOPUS:85036535466
SN - 0738-1085
VL - 38
SP - 479
EP - 488
JO - Microsurgery
JF - Microsurgery
IS - 5
ER -