Impact of Rectus Muscle Injury during Perforator Dissection on Functional Donor Morbidity after Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Abstract

Background:This study aimed to assess the extent of rectus muscle damage in deep inferior epigastric perforator (DIEP) flap harvest and to evaluate its association with functional donor morbidity.Methods:A prospective cohort of 76 patients who underwent DIEP flap breast reconstruction was evaluated preoperatively and followed up for 1 year. Abdominal wall strength was assessed using the upper and lower rectus abdominis manual muscle function tests. Functional weakness was defined as a postoperative decrease in function by at least 2 scores. The effects of patient- and operation-related characteristics on adverse outcomes were also assessed.Results:The mean width of the transected rectus muscle was 2.2 cm (partial thickness, 1.8 cm; full thickness, 0.4 cm). The mean width ratio of the overall injured muscle to the entire bilateral muscle was 0.18. Muscle injury was more severe in the cases with bipedicled flap elevation and in those with 4 or more perforators harvested. Functional weakness was detected in 13 patients (17.1%). Multivariate analyses demonstrated that the width ratio of the muscle injury was an independent predictor of functional weakness. The width ratio achieved maximal discrimination regarding the rate of functional weakness at a threshold value of 0.12, indicating that functional weakness did not develop in all 19 cases with a width ratio of <0.12.Conclusions:The extent of rectus muscle injury during perforator dissection may be associated with functional donor morbidity after DIEP flap harvest. This may be beneficial in achieving proper balance between securing flap perfusion and preserving donor functions.

The Role of Measurement of Pedicle Length for DIEP Flap Transferring in Breast Reconstruction

“…We found that it might be helpful to perform microvascular anastomosis appropriately, and too short or too long pedicle would be vascular torsion, kinking, and twisting, leading to postoperative vascular thrombosis and flap failure. According to our practice, the vascular pedicle should be designed individually other than expose entirely, to reduce undue intramuscular dissection of vascular pedicle and lower the risk of donor site morbidity and complication rate ultimately 4,5 . In the present study, we evaluated the efficacy and safety of the preoperative pedicle measuring technique in DIEP free flap for breast reconstruction.…”

“…According to our practice, the vascular pedicle should be designed individually other than expose entirely, to reduce undue intramuscular dissection of vascular pedicle and lower the risk of donor site morbidity and complication rate ultimately. 4,5 In the present study, we evaluated the efficacy and safety of the preoperative pedicle measuring technique in DIEP free flap for breast reconstruction. A randomized prospective controlled study was to evaluate the role of this novel measuring technique compared with the conventional method.…”

Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics

“…In addition, msTRAM flap may avoid intramuscular perforator dissection that has the potential denervate and traumatize the rectus muscle, which has shown to result in donor site morbidity in DIEP flap harvest. [15] With the routine use of mesh, the deleterious effects of muscle and fascia harvest are mitigated. The relative paucity of fTRAM flap harvest reflect an effort to preserve both functional rectus muscle as well as anterior rectus sheath.…”

A New CT Analysis of Abdominal Wall after DIEP Flap Harvesting

“…Some authors have investigated the complications occurring in the abdominal wall after the DIEP flap harvest. None of these authors correlated any anatomical degenerative finding, instrumentally detected, with the possible variations in the strength and functionality of the muscle itself [14][15][16][17][18].…”