DIEP Flaps in Women with Abdominal Scars: Are Complication Rates Affected?

Abstract

With minor technical modifications, DIEP flaps can be performed successfully without increased flap complications in patients with preexisting abdominal incisions. Despite these design modifications, patients should be informed of an increased risk for donor-site complications.

Smoking increases donor site complications in breast reconstruction with DIEP flap

“…The slight difference between CTA and US in favour of US can hardly be explained by the fact that CTA from June 2013 was utilised in patients with scars after previous abdominal surgery. Although there are reports that show that abdominal scars are associated with an increase in complication rates [28], we did not find such a significant correlation.…”

Abdominal Wall Stability and Flap Complications after Deep Inferior Epigastric Perforator Flap Breast Reconstruction

“…Coinciding with previous series, 21,24,26,27 the current study reports a 6.5 percent incidence of seroma formation. Moreover, formation of donorsite seromas were not increased despite increasing body mass index, in contrast to previous studies following either DIEP 24,26 or TRAM flap-based 11,18 reconstruction.…”

“…Of note, morbidly obese patients reported an increased number of previous open abdominal operations, which has been associated with significantly increased delayed wound healing following DIEP flap surgery. 27 Supported by the current findings and significant personal experience, we suggest that additional emphasis be placed on the risk of abdominal wound healing complications when counseling patients with a high body mass index preoperatively.…”

“…Reported rates of fat necrosis following DIEP flap reconstruction are varied in the literature, ranging from 1.8 to 29 percent. 9,13,17,19,21,22,[25][26][27][28] In the current study overall, clinical fat necrosis was evident in 10.4 percent of DIEP flaps. Stratified by body mass index, rates of fat necrosis were unaffected by body habitus, as reported previously for pedicled 18 and free TRAM flaps.…”

A Classification System for Partial and Complete DIEP Flap Necrosis Based on a Review of 17,096 DIEP Flaps in 693 Articles Including Analysis of 152 Total Flap Failures

“…DIEP total failure rate ranges from 0 percent [24][25][26] to 10 percent 27 in the literature, with most larger series including more than 30 DIEP flaps reporting rates of less than 3 percent. [28][29][30] The largest number of total flap failures in any given series is 11 (2 percent) of 564 DIEP flaps. 31 This article is composed of two parts.…”