Summary
The deep inferior epigastric perforator (DIEP)-flap continues to be the standard treatment
in microsurgical breast reconstruction. Reasons for the popularity of the DIEP-flap
include the availability of a large amount of tissue for the reconstruction of large
breasts, a reliable vascular anatomy and an aesthetically pleasing donor site scar.
However, the DIEP-flap is not considered the optimal choice as the donor tissue in
all patients. Previous abdominal surgeries with resulting scars may threaten the success
of a free DIEP-flap due to compromised vascularity within the flap. We elaborated
a technique to increase the safety of breast reconstruction with the DIEP-flap in
the presence of an infraumbilical vertical scar.
After raising the DIEP-flap in a traditional manner on one side with harvesting of
a considerate length of the inferior epigastric vessels, a segment of the superior
epigastric vessels is left attached to the main pedicle. This stump of the superior
epigastric vessels is now anastomosed under the microscope to a paraumbilical perforator
on the contralateral side of the flap for in-flap microvascular augmentation.
The above-mentioned technique was applied in five patients who presented with an infraumbilical
vertical scar and were reconstructed with a DIEP-flap because of breast cancer. In
three of the five patients there was an additional risk factor present such as smoking
or diabetes mellitus. In all five patients no major complication due to marginal perfusion
of the contralateral side of the flap was encountered. In two patients there was minor
breakdown of fatty tissue that was managed conservatively in both cases.
In-flap microvascular augmentation of DIEP-flaps is a valuable tool for the plastic
surgeon in microvascular breast reconstruction. It permits usage of the lower abdominal
tissue even if perfusion is compromised due to midline scarring. We recommend this
technique as a safe alternative in patients seeking autologous breast reconstruction
in the presence of a midline abdominal scar.
Keywords
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Article info
Publication history
Published online: January 22, 2007
Accepted:
November 4,
2006
Received:
March 29,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Refinements of the deep inferior epigastric perforator (DIEP) flap for optimal blood supply: Reply to ‘Schoeller T, Wechselberger G, Roger J, Hussl H, Huemer GM. Management of infraumbilical vertical scars in DIEP-flaps by crossover anastomosis. 2007;60:524-8.Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 61Issue 4
- PreviewWe read with interest the paper by Schoeller et al.1 to increase the safety of the DIEP flap in patients with an infraumbilical scar. They describe clearly ‘in flap microvascular augmentation’, by anastomosing the superior epigastric vessels of the DIEP flap to a contralateral paraumbilical perforator.
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