A Strategic Approach for DIEP Flap Breast Reconstruction in Patients With a Vertical Midline Abdominal Scar

Abstract

The hemi-DIEP flap is a safer method for the patient with a lower abdominal midline scar but limits the reconstructive volume. Carefully evaluating the perfusion across midline scar intraoperatively is crucial for deciding how much contralateral tissue should be discarded. Double pedicles anastomosis is an assurance for using entire DIEP flap with lower midline scar.

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

“…Many surgical pearls have been described to optimize flap dissection in the presence of abdominal scars, including subcostal, midline, and Pfannenstiel scars. [23][24][25][26] Although multiple strategies exist to provide safe DIEP flap reconstruction to women with history of previous abdominal surgeries, they should be informed preoperatively that they are at a 1.8 times increased risk of donor-site wound healing complications, with a 14% chance of having a donor-site open wound in our study, as compared with patients with no prior abdominal surgery.…”

Anatomical features associated with venous congestion in DIEP flap using CT angiography with three-dimensional reconstruction

“…[10][11][12] However, the origin remains to be elucidated. Some triggering factors have been proposed: diameter of the SIEV larger than 1.5 mm, [6,13] absence of communications of both SIEVs crossing the abdominal midline, [6,13] absence of direct communications by perforators between the SIEV and the deep inferior epigastric vein (DIEV), [6] number of perforators of the flap, [5] and subcutaneous tissue thickness.…”

DIEP flap breast reconstruction preserving a lumbar peritoneal shunt tube

“…However, it cannot be performed safely in cases where the deep inferior epigastric vessels or its perforator vessels are damaged or the subcutaneous circulation of the lower abdomen is inhibited. The presence of a vertical midline abdominal scar has been regarded as a relative contraindication to DIEP flap reconstruction [5]. In the past decade, some authors have reported that DIEP flap reconstruction can be successfully performed in patients with vertical abdominal scars [2,6] or a past history of multiple abdominal liposuction procedures [3].…”

“…In the past decade, some authors have reported that DIEP flap reconstruction can be successfully performed in patients with vertical abdominal scars [2,6] or a past history of multiple abdominal liposuction procedures [3]. Furthermore, the indications for DIEP flap reconstruction are currently expanding due to intraoperative perfusion assessment using indocyanine green angiography [7] and crossover vascular anastomosis within the flap [5,8]. …”