The use of lower abdominal perforator flaps in soft‐tissue reconstruction after sarcoma resection

Abstract

Background Historically, conventional musculocutaneous flaps have been commonly used for reconstruction after soft tissue sarcoma resection, and the use of lower abdominal perforator flaps has not been popular. This report examined the current role of lower abdominal perforator flaps in sarcoma treatment. Methods We reviewed the outcomes of 14 patients (mean age: 46.3 years, range: 18–79 years) who underwent immediate reconstruction with a deep inferior epigastric artery perforator (DIEP) flap or a superficial inferior epigastric artery (SIEA) flap after sarcoma resection. The defects ranged in size from 7 × 6 cm2 to 25 × 22 cm2 (mean: 16.5 × 12.1 cm2). An oblique design was used for pedicled DIEP flaps and a transverse design for free DIEP flaps. Results Free SIEA flaps were used in six patients, pedicled DIEP flaps in five, and free DIEP flaps in three. The flaps ranged in size from 13 × 8 cm2 to 36 × 12.5 cm2 (mean: 23.1 × 9.2 cm2). All DIEP flaps except one were harvested based on one dominant perforator. All flaps survived without vascular compromise. Surgical site infection and seroma occurred at the recipient site in one patient each. No donor‐site complications occurred. Conclusions Lower abdominal perforator flaps can serve as a versatile donor site for reconstruction after sarcoma resection.

The deep inferior epigastric artery perforator flap: a narrative review on its various uses in non-breast reconstruction

“…The authors found that in most cases, a pedicled flap was used, with the ALT flap being the most common. Our literature review found four other case reports or case series (47,48,117,119). All cases utilized the DIEP flap in pedicled fashion.…”

“…All were reconstruction cases after sarcoma resection (41)(42)(43)(44)(45)48). All authors used the DIEP flap in pedicled fashion (41,43,(47)(48)(49) except Bota et al (42), who described raising an abdominoplasty-like paddle and transferred it as a free flap. Scaglioni et al (41).…”

Response to letter commenting on “The use of lower abdominal perforator flaps in soft‐tissue reconstruction after sarcoma resection”

“…Response to letter commenting on "The use of lower abdominal perforator flaps in soft-tissue reconstruction after sarcoma resection" We thank Dr. Giunta et al for their comments on our article, "The use of lower abdominal perforator flaps in soft-tissue reconstruction after sarcoma resection," (Miyamoto, Arikawa, & Kagaya, 2020) and for reporting their experience with a pedicled transverse deep inferior epigastric artery perforator (DIEP) flap (Giunta, De Brucker, & Hamdi, 2020).…”

“…Distal circulation of the DIEP flap is more stable with the oblique design, and the flap can be safely harvested to the mid-axillary line. (Miyamoto et al, 2020). A 51-year-old woman presented with a recurrent angiosarcoma on her back.…”

Comments on “The use of lower abdominal perforator flaps in soft‐tissue reconstruction after sarcoma resection”

“…We read with interest the article by Miyamoto, Arikawa, and Kagaya regarding the use of lower abdominal perforator flaps in reconstruction after sarcoma resection (Miyamoto, Arikawa, & Kagaya, 2020).…”