The Impact of Perforator Number on Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Abstract

BackgroundPerforator flaps minimize abdominal site morbidity during autologous breast reconstruction. The purpose of this study was to assess whether the number of perforators harvested influences the overall deep inferior epigastric perforator (DIEP) flap survival and flap-related complications.MethodsA retrospective review was performed of all DIEP flaps performed at the Hospital of the University of Pennsylvania from 2006 to 2011. The outcomes assessed included flap loss and major complications. We compared flaps by the number of total perforators (1-4) and then carried out a subgroup analysis comparing flaps with one perforator to flaps with multiple perforators. Lastly, we conducted a post-hoc analysis based on body mass index (BMI) categorization.ResultsThree hundred thirty-three patients underwent 395 DIEP flaps. No significant differences were noted in the flap loss rate or the overall complications across perforator groups. However, the subgroup analysis revealed significantly higher rates of fat necrosis in the case of one-perforator flaps than in the case of multiple-perforator flaps (10.2% vs. 3.1%, P=0.009). The post-hoc analysis revealed a significant increase in the flap loss rate with increasing BMI (<30=2.0%, 30-34.9=3.1%, 35-39.9=3.1%, >40=42.9%, P<0.001) in the DIEP flaps, but no increase in fat necrosis.ConclusionsThis study demonstrates that the number of perforators does not impact the rate of flap survival. However, the rate of fat necrosis may be significantly higher in DIEP flaps based on a single perforator. Multiple perforators should be utilized if possible to decrease the risk of fat necrosis.

Smoking increases donor site complications in breast reconstruction with DIEP flap

“…This finding is supported from a theoretical point of view by Patel and Keller [24]. However, other studies, for instance by Grover et al [25] and Baumann et al [26], show that the rate of fat necrosis is higher in DIEP flaps based on a single perforator. In the present study, we found no difference in complication rates depending on the number of perforators.…”

The DIEP flap breast reconstruction: Starting from scratch in a university hospital

“…Despite a statistical increase of flap perforators, the complication rate remained stable. Moreover, in a recent study, Grover et al demonstrated that the number of perforators had no impact on the rate of flap survival and found a significantly higher rate of fat necrosis in the case of one-perforator flaps than in the case of multiple-perforator flaps [23].…”

Techniques and Perforator Selection in Single, Dominant DIEP Flap Breast Reconstruction: Algorithmic Approach to Maximize Efficiency and Safety

“…4,6,9,18,19 The use of single perforators has been associated with higher rates of fat necrosis in clinical studies 18 and up to 25 percent in single-dominant perforator DIEP flaps. 4,6,9,18,19 The use of single perforators has been associated with higher rates of fat necrosis in clinical studies 18 and up to 25 percent in single-dominant perforator DIEP flaps.…”

“…9 (See Video, Supplemental Digital Content 4, which shows the perforator exploration and dissection and intramuscular pedicle dissection of the DIEP flap with preservation of traversing motor nerves to the rectus muscle, available in the "Related Videos" section of the full-text article on PRSJournal.com or, for Ovid users, available at http://links.lww.com/PRS/B884.) 9 (See Video, Supplemental Digital Content 4, which shows the perforator exploration and dissection and intramuscular pedicle dissection of the DIEP flap with preservation of traversing motor nerves to the rectus muscle, available in the "Related Videos" section of the full-text article on PRSJournal.com or, for Ovid users, available at http://links.lww.com/PRS/B884.)…”