The unilateral deep inferior epigastric perforator flap: Comparing university to community hospital

Wildt, Ramon P. de; Enajat, Morteza; Sawor, John H.; Fresow, Roel N. G. M.; Nanhekhan, Lloyd; Hulst, René R W J van der

doi:10.3109/2000656x.2012.686915

Cited by 9 publications

(5 citation statements)

References 9 publications

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“…The outcomes reported in the literature include a reoperation rate of up to 17% with a flap loss of approximately 5%. 16,17 The prolonged duration of this procedure along with the feared complication of flap loss has created a stigma among the general and plastic surgery communities of being a more complex and arduous process for breast reconstruction. 18 The goal of our study is to show that DIEP flap breast reconstruction can be done efficiently with good outcomes.…”

mentioning

confidence: 99%

Optimizing Efficiency in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Cañizares¹,

Mayo²,

Soto³

et al. 2015

Annals of Plastic Surgery

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mentioning

confidence: 99%

Optimizing Efficiency in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Cañizares¹,

Mayo²,

Soto³

et al. 2015

Annals of Plastic Surgery

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“…In total, 61 full-text articles were included for data extraction, representing a total of 24,742 free-flaps for breast reconstruction. Fourteen of the studies were PAP focused, 7,8,15–25 six were LAP focused, 12,13,26–29 and 41 were DIEP focused 2,12,15,30–66 . Of the PAP focused papers, three included outcomes from stacked PAP flaps for unilateral breast reconstruction 8,16,20 .…”

Section: Resultsmentioning

confidence: 99%

Alternatives to the Gold Standard: A Systematic Review of Profunda Artery Perforator and Lumbar Artery Perforator Flaps for Breast Reconstruction

Minkhorst,

Castanov,

et al. 2024

Ann Plast Surg

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Introduction Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap is the current gold-standard autologous option. The profunda artery perforator (PAP) and lumbar artery perforator (LAP) flaps have more recently been described as alternatives for patients who are not candidates for a DIEP flap. The aim of this study was to review the survival and complication rates of PAP and LAP flaps, using the DIEP flap as a benchmark. Methods A literature search was conducted using PubMed, MEDLINE, Embase, BIOSIS, Web of Science, and Cochrane databases. Papers were screened by title and abstract, and full texts reviewed by three independent blinded reviewers. Quality was assessed using MINORS criteria. Results Sixty-three studies were included, for a total of 745 PAP, 62 stacked PAP, 187 LAP, and 23,748 DIEP flap breast reconstructions. The PAP (98.3%) had comparable success rate to DIEP (98.4%), and the stacked PAP (88.7%) and LAP (92.5%) success rate was significantly lower (P < 0.0001). The PAP and LAP groups both had a low incidence of fat necrosis. However, the revision rate for the LAP group was 16.1% whereas the PAP group was 3.3%. Donor site wound dehiscence rate was 2.9 in the LAP group and 9.1% in the PAP group. Conclusions Profunda artery perforator and DIEP flaps demonstrate very high rates of overall survival. The LAP flap has a lower survival rate. This review highlights the survival and complication rates of these alternative flaps, which may help clinicians in guiding autologous reconstruction technique when a DIEP flap is unavailable.

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“…Breast reconstruction is offered in academic medical centers and community‐based practices . To date, no study has evaluated the varying demographics, medical comorbidities, or reconstructive outcomes of breast reconstructions performed by academic and community‐based plastic surgeons.…”

Section: Introductionmentioning

confidence: 99%

Breast reconstruction patterns and outcomes in academic and community practices within a single institution

et al. 2019

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Breast reconstruction is a common procedure that is performed in both community and academic settings. At Yale‐New Haven Hospital (YNHH), both academic (AP) and community‐based (CP) plastic surgeons perform breast reconstructions. We aim to compare practice patterns in breast reconstruction between two practice environments within a single institution. A retrospective chart review of all breast reconstructions at YNHH between 2013 and 2018 was performed. Data collected included demographics, preoperative history, and postoperative outcomes. Results were further subdivided by practice setting. A total of 1045 patients (1683 breasts) underwent breast reconstruction during the study period. About 52.8% were performed by AP while 47.2% were performed by CP. CP had higher rates of autologous reconstruction (P < .001) and nipple‐sparing mastectomy (P < .0001). Age and BMI were similar between the cohorts. However, patients cared for by AP had 2.6% increased prevalence of diabetes (P = .064), 5.5% greater prevalence of psychiatric diagnoses (P = .004), and 7.1% higher open abdominal surgery rates (P < .001). Outcomes were similar between the groups except for higher infection rates (P = .027) and explant rates (P = .003) in the CP cohort. When evaluating insurance status, the AP cohort had 30.5% fewer patients with commercial insurance, 16.7% more patients with Medicaid and 6.1% more patients with Medicare (P < .001). Within our institution, academic and community‐based plastic surgeons perform breast reconstruction with overall similar complication rates. Patients treated by AP have a higher rate of preoperative medical and psychiatric comorbidities. Patients treated by CP have higher rates of infection and implant explant. AP plastic surgeons care for a significantly higher rate of Medicare and Medicaid patients with proportionally fewer patients with commercial insurance.

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The unilateral deep inferior epigastric perforator flap: Comparing university to community hospital

Cited by 9 publications

References 9 publications

Optimizing Efficiency in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Optimizing Efficiency in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Alternatives to the Gold Standard: A Systematic Review of Profunda Artery Perforator and Lumbar Artery Perforator Flaps for Breast Reconstruction

Breast reconstruction patterns and outcomes in academic and community practices within a single institution

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