Deep inferior epigastric perforator flap for breast reconstruction: experience with 43 flaps
- Author:
- No author available
- Journal Title:
- CHINESE MEDICAL JOURNAL
- Issue:
- 5
- DOI:
- No doi available
- Key Word:
- mammaplasty;surgical flaps;deep inferior epigastric perforator flap
Abstract： Background In the past decade, there has been increasing breast reconstructions after mastectomy. The ideal material for reconstruction of a breast is fat and skin. The transverse rectus abdominis myocutaneous (TRAM) flap has been the gold standard for breast reconstruction until recently. Abdominal wall function is a major concern for plastic surgeons in breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore preserves adequate abdominal wall competence. The aim of this study was to summarize our experience in breast reconstruction with DIEP flap.Methods Between March 2000 and August 2005, a total of 43 breast reconstructions were performed on 40 patients by our surgeons using DIEP flap (3 patients had bilateral procedures), 14 of them were immediate surgeries and 26 were delayed. Abdominal function, satisfaction with the donor site and reconstructed breast, and the sensation recovery was assessed respectively during follow-up.Results The mean age of the patients was 38.6 years (range, 28-50). The size of the flaps was 11 cm×26 cm in average (height 10-12 cm, width 15-33 cm). The mean length of the vascular pedicles was 9.3 cm (range, 7-12). The patients were followed up for a mean of 16 months (range, 6-30 months). During the follow-up, 2 (5%) patients had total flap loss, 2 (5%) had partial necrosis, 4 (9%) had wound edge necrosis in the abdomen, and 1 had axillary seroma. None of the patients had hernia, and all of them were able to resume their daily activities after the operation. Patient satisfaction with the reconstructed breast rated high, 95% of the patients achieved spontaneous return of sensation in the reconstructed breast, but none of them had a sensation equivalent or approximate to the normal.Conclusions The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectus muscle. It can reduce donor-site morbidity and provide an aesthetic refinement in breast reconstruction.
- [1]徐军,靳小雷,刘元波,等.应用腹壁下动脉穿支游离皮瓣移植乳房再造[J].2004,(2).
- [2]Chiu ES,Allen RJ,Granzow JW,etc.Breast reconstruction with the deep inferior epigastric perforator flap: history and an update on current technique.[J].2006,59(6).
- [3]Lundberg J,Mark H.Avoidance of complications after the use of deep inferior epigastric perforator flaps for reconstruction of the breast.[J].2006,40(2).
- [4]J Arthur, Jensen.Tram flap delay: two techniques and an unresolved question.[J].2003,111(7).
- [5]P.N. Blondeel.One hundred free DIEP flap breast reconstructions: a personal experience[J].1999,52(2).
- [6]Beckenstein MS,Arkoulakis NS,Grotting JC.The art and science of autologous breast reconstruction.[J].2003,9(5).
- [7]Rasheed T,Macmillan RD,McCulley SJ,etc.Oncological and cosmetic outcomes of oncoplastic breast conserving surgery.[J].2005,31(8).
- [8]Alex Keller.The Deep Inferior Epigastric Perforator Free Flap for Breast Reconstruction[J].2001,46(5).
- [9]LeeClara N.,FosterRobert D..Breast Reconstruction after Mastectomy in Young Women[J].2005,23.
- [10]I, Koshima,S, Soeda.Inferior epigastric artery skin flaps without rectus abdominis muscle.[J].1989,42(6).
- [11]P N, Blondeel,W D, Boeckx.Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery.[J].1994,47(7).
- [12]Phillip N. Blondeel,Guy Beyens,Raymond Verhaeghe,etc.Doppler flowmetry in the planning of perforator flaps[J].1998,51(3).
- [13]Moustapha Hamdi,Eva Weiler-Mithoff,Martyn Webster.Deep Inferior Epigastric Perforator Flap in Breast Reconstruction: Experience with the First 50 Flaps[J].1999,103(1).
- [14]Agnes Hermanson,Carl-Johan Dalsgaard,Claes Arnander,etc.Sensibility and Cutaneous Reinnervation in Free Flaps[J].1987,79(3).
- [15]Allen RJ,Gill PS,Dellacroce FJ,etc.A 10-year retrospective review of 758 DIEP flaps for breast reconstruction.[J].2004,113(4).
- [16]Serletti JM.Breast reconstruction with the TRAM flap: pedicled and free.[J].2006,94(6).
- [17]Avila RA,Grossman L,Dulin WA,etc.Evaluation of abdominal wall strength after TRAM flap surgery.[J].2004,113(6).
- [18]D, Harcourt,N, Rumsey.Psychological aspects of breast reconstruction: a review of the literature.[J].2001,35(4).
- [19]Munhoz AM,Ishida LH,Sturtz GP,etc.Importance of lateral row perforator vessels in deep inferior epigastric perforator flap harvesting.[J].2004,113(2).
- [20]Maurice Y, Nahabedian.Symmetrical breast reconstruction: analysis of secondary procedures after reconstruction with implants and autologous tissue.[J].2005,115(1).
- [21]Guerra Aldo Benjamin,Metzinger Stephen Eric,Bidros Rafi Sirop,etc.Bilateral Breast Reconstruction with the Deep Inferior Epigastric Perforator (DIEP) Flap[J].2004.
- [22]Vandevoort M,Fabre G,Vranckx JJ.Perforator topography of the deep inferior epigastric perforator flap in 100 cases of breast reconstruction.[J].2002,109(6).
- [23]C, Lehmann,R, Gumener,D, Montandon.Sensibility and cutaneous reinnervation after breast reconstruction with musculocutaneous flaps.[J].1991,26.
- [24]Munhoz AM,Ishida LH,Duarte GG,etc.Aesthetic refinements in breast augmentation with deep inferior epigastric perforator flap: a case report.[J].2003,27(2).
- [25]Munhoz AM,Sturtz G,Montag E,etc.Clinical outcome of abdominal wall after DIEP flap harvesting and immediate application of abdominoplasty techniques.[J].2005,116(7).
- [26]Chiu ES,Allen RJ,Granzow JW,etc.Breast reconstruction using perforator flaps.[J].2006,94(6).
- [27]R J, Allen,P, Treece.Deep inferior epigastric perforator flap for breast reconstruction.[J].1994,32.