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

Ochoa, Oscar; Chrysopoulo, Minas; Nastala, Chet; Ledoux, Peter; Pisano, Steven

doi:10.1097/prs.0b013e3182547d09

Cited by 81 publications

(19 citation statements)

References 32 publications

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“…The result was consistent with the reported literature [24, 41]. The incidence of wound dehiscence was more common with a rate of 6% (95% CI: 4%–9%), which was almost equal to the DIEP flap [47, 48] (Knox ADC et al reported that the rate was 6%, and Ochoa O et al reported that the rate was 6.2%) and less than the TUG flap [17] (Schoeller T et al indicated that the rate was 7.3%). Just as the literature reported, maybe a semicircular incision or postoperative supine position or sitting position disturbed normal wound healing.…”

Section: Discussionsupporting

confidence: 91%

“…Various complications were summarized in Table 2. The result was almost equal to that of the DIEP flap (Ochoa O et al reported that the rate of DIEP was 23.8% [48]) and less than muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) or superficial inferior epigastric artery (SIEA, Wang X-L et al reported that the rates of MS-TRAM and SIEA were 25.6% and 26.7%, respectively [49]). Thirdly, almost all included studies showed a satisfactory aesthetic outcome of the donor site, such as minimal contour deformity or invisible incision scar [24, 27, 34, 41].…”

Section: Discussionmentioning

confidence: 95%

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A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction

Qian

Xiong

et al. 2019

Journal of Oncology

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Background. The profunda artery perforator (PAP) flap was first applied in breast reconstruction in 2010 by Robert J. Allen. It provided an alternative for autologous breast reconstruction in addition to traditional donor sites. Currently, literature reporting its microsurgical safety and efficacy is relatively sparse and heterogeneous. Objective. To clarify the evidence regarding microsurgical safety and efficacy of PAP flap in breast reconstruction, which may contribute to future surgical decision-making. Methods. Multiple databases were systematically searched by two independent reviewers. The result was statistically analyzed with Meta command of R GUI 3.5.1. The proportions with 95% confidence intervals (CIs) were calculated by using random-effect model. Results. There were 12 studies including 516 PAP flaps meeting the inclusion criteria. The pooled surgical success rate was 99% (95% CI: 97%–100%) and overall rate of complications was 23% (95% CI: 18%–27%). The most common individual complication was wound dehiscence with incidence of 6% (95% CI: 4%–9%). The seroma rate was 2% (95%CI: 0%–6%). The hematoma rate was 1% (95% CI: 0%–2%). The partial necrosis rate was 2% (95% CI: 0%–5%). The rate of total flap loss was 1% (95% CI: 0%–3%). Conclusion. To date, this study is the first meta-analysis of microsurgical efficacy and safety evaluation of the PAP flap in breast reconstruction. This present work confirmed that the PAP flap is safe and reliable in breast reconstruction with high success rate, but a relatively low complication rate. Moreover, it might be more than an alternative to the deep inferior epigastric perforator flap (DIEP) in microsurgical breast reconstruction in selected patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction

Qian

Xiong

et al. 2019

Journal of Oncology

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“…First, Chang et al observed significantly higher rates of complications in overweight and obese patients having a breast reconstruction with free TRAM flaps [1]. Besides higher frequencies of lower abdominal bulging and herniation due to increased intraabdominal pressure in overweight patients [17,18], several studies confirmed a significantly higher overall risk for complications after reconstructions with abdominal based free flaps [3,4,[19][20][21][22][23]. As an example, Boczar et al [4] observed a reoperation rate of about 40% in obese patients and severe wound complications.…”

Section: Discussionmentioning

confidence: 99%

Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

Schwaiger

Weitgasser

Mahrhofer

et al. 2021

JCM

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Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI.

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“…The success of a DIEP flap-based breast reconstruction depends on several factors; For instance, the perfusion of transferred flap is the most important factor that determines postoperative complications. Standards of perfusion monitoring of DIEP-flap should be carried out by observing temperature, vascular pulse, vessel diameter correlation, capillary response prior to surgical intervention (7,14,(20)(21)(22). To decrease the overall complication rate, it is necessary to understand the "dynamics and anatomy of blood flow" through the deep and superior inferior epigastric systems (7).…”

Section: Preoperative Periodmentioning

confidence: 99%

Patient Management Strategies in Perioperative, Intraoperative, and Postoperative Period in Breast Reconstruction With DIEP-Flap: Clinical Recommendations

et al. 2022

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Background and ObjectiveDeep Inferior Epigastric Perforator (DIEP) flap is a tissue isolated from the skin and subcutaneous tissue of the lower abdomen or rectus muscle to foster breast reconstruction. There is limited information about DIEP-flap induced complications associated with breast reconstruction surgery.EvidenceWe conducted a systematic review of the published literature in the field of breast cancer reconstruction surgery. Information was gathered through internet resources such as PubMed, Medline, eMedicine, NLM, and ReleMed etc. The following key phrases were used for effective literature collection: “DIEP flap”, “Breast reconstruction”, “Patient management”, “Postoperative DIEP”, “Intraoperative anticoagulant therapy”, “Clinical recommendations”. A total of 106 research papers were retrieved pertaining to this systematic review.ConclusionA successful breast reconstruction with DIEP-flap without complications is the priority achievement for this surgical procedure. This study provides various evidence-based recommendations on patient management in the perioperative, intraoperative, and postoperative periods. The clinical recommendations provided in this review can benefit surgeons to execute breast reconstruction surgery with minimal postoperative complications. These recommendations are beneficial to improve clinical outcomes when performing surgery by minimizing complications in perioperative, intraoperative, and postoperative period.

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

Cited by 81 publications

References 32 publications

A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction

A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction

Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

Patient Management Strategies in Perioperative, Intraoperative, and Postoperative Period in Breast Reconstruction With DIEP-Flap: Clinical Recommendations

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