Harvesting free abdominal perforator flaps in the presence of previous upper abdominal scars

Hamdi, Moustapha; Larsen, Mikko; Craggs, Barbara; Vanmierlo, Bert; Zeltzer, Assaf

doi:10.1016/j.bjps.2013.10.047

Cited by 30 publications

(21 citation statements)

References 17 publications

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“…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.…”

Section: Discussionmentioning

confidence: 97%

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

Daly

Doval

Lin

et al. 2020

J Reconstr Microsurg

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Background This study examines the effect of prior abdominal surgery on flap, donor-site, and overall complications in women undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction and assesses whether preoperative computed tomography angiography (CTA) affects outcomes. Methods All DIEP flaps performed at our institution between 2004 and 2015 were identified retrospectively. Patients were stratified based on a history of prior abdominal surgery and whether or not they underwent a preoperative CTA. A subgroup analysis was performed to compare operative times and incidence of complications using adjusted odds ratios (ORs). Results Over a 12-year period, 425 patients (640 flaps) had prior abdominal surgery, and 393 patients (547 flaps) had no prior abdominal surgery. Of the patients with previous abdominal surgery, 67 (15.7%) underwent preoperative CTA and 333 (78.4%) did not. Patients with prior abdominal surgery were more likely to have donor-site wound complications (OR: 1.82, 95% confidence interval [CI]: 1.15–2.87, p = 0.01), fat necrosis ≥2cm of the transferred flap (OR: 1.39, 95% CI: 1.0–1.94, p = 0.05), and were more likely to have bilateral DIEP flap reconstruction (OR: 1.61, 95% CI: 1.22–2.12, p < 0.001). Preoperative CTA did not reduce the risk of complications and did not affect operative times. Conclusion DIEP flap reconstruction can be safely performed in women with prior abdominal surgery. However, these patients should be counseled that they are at an increased risk for donor-site wound breakdown and fat necrosis of the reconstructed breast. Preoperative CTA does not reduce complication rate, overall operative time, or time needed to dissect perforators in women with abdominal scars.

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Section: Discussionmentioning

confidence: 97%

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

Daly

Doval

Lin

et al. 2020

J Reconstr Microsurg

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“…Large studies have documented its safety and efficacy. 33 Its harvest following previous abdominal suction lipectomy, in contrast, is somewhat controversial. 31 Improvements in flap design and refinements in surgical technique have been made possible by anatomical studies that have increased our knowledge of the blood supply to muscle, subcutaneous fat, and the overlying skin.…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Laser Angiography Improves Deep Inferior Epigastric Perforator Flap Outcomes following Abdominal Suction Lipectomy

Casey

Connolly

Nanda

et al. 2015

Plastic and Reconstructive Surgery

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“…Modification to flap design have been suggested by skewing the flap more distally or obliquely away from the scar allowing safe flap harvesting minimizing abdominal closure flap complications . However the abdominal scar from flap harvesting may result sometimes with an unaesthetic outcome, because of the oblique or very high orientation of the flap.…”

Section: Discussionmentioning

confidence: 99%

Tips and tricks for DIEP flap breast reconstruction in patients with previous abdominal scar

et al. 2015

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The aim of this study was to analyze outcomes of patients who had prior abdominal operations and underwent DIEP flap breast reconstruction and to describe technical strategies to insure well-vascularized flap-harvest minimizing abdominal donor-site complications. All patients who underwent DIEP flap breast reconstruction between 2004 and 2014 were reviewed and divided into a control group (CG) and a scar group (SG). Patient demographics, operative details, flap and donor-site complications were analyzed and compared. For all of the scars, DIEP flap design was not modified, but a standardized approach was developed according to the type and location of the scar, available vascular pedicle, perforator locations, and the required flap tissue for breast reconstruction. Two hundred and eighty patients underwent 292 flaps in CG and 107 underwent 111 flaps in SG. Pfannenstiel, McBurney, laparoscopic, midline and subcostal were the most common previous incisions. There were no significant differences between groups regarding demographics, flap and mastectomy weight, active smoking, or radiation status (P > 0.05). No significant differences were observed in DIEP flap loss (P = 0.909), partial flap loss (P=0.799), or fat necrosis (P=0.871) and in the rate of abdominal donor-site complications between groups (P > 0.05). SG had a significantly higher mean operative time than CG (P=0.034). Medial raw was a negative risk-factor for flap complications, while BMI (>25.1 kg/m ) and smoking-history were significant predictors for donor-site complications. With careful preoperative planning and appropriate technical strategies, successfully DIEP flap breast reconstruction can be performed without increased flap and donor-site complications in patients with preexisting abdominal scars. © 2015 Wiley Periodicals, Inc. Microsurgery 37:282-292, 2017.

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Harvesting free abdominal perforator flaps in the presence of previous upper abdominal scars

Cited by 30 publications

References 17 publications

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

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

Indocyanine Green Laser Angiography Improves Deep Inferior Epigastric Perforator Flap Outcomes following Abdominal Suction Lipectomy

Tips and tricks for DIEP flap breast reconstruction in patients with previous abdominal scar

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