Clinical application and planning strategy of bipedicled deep inferior epigastric perforator flaps in delayed breast reconstruction
10.3760/cma.j.cn114453-20200525-00320
- VernacularTitle:双血管蒂腹壁下动脉穿支皮瓣在乳房再造中的临床应用
- Author:
Boyang XU
1
;
Su FU
;
Minqiang XIN
;
Dali MU
;
Chunjun LIU
;
Jie LUAN
Author Information
1. 中国医学科学院北京协和医学院整形外科医院乳房整形中心 100144
- Keywords:
Mammaplasty;
Abdominal wall;
Perforator flap;
Free tissue flaps
- From:
Chinese Journal of Plastic Surgery
2021;37(7):712-718
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Introducing clinical application, planning strategy, and surgical tips of bipedicled deep inferior epigastric perforator (DIEP) flaps in delayed breast reconstruction.Methods:A retrospective study of patients who underwent delayed breast reconstruction using bipedicled DIEP flaps from April 2015 to April 2019 at the facility of the authors was carried out. Preoperative CT angiograph was performed for evaluation of deep inferior epigastric perforators. Intraoperative indocyanine green angiography was performed for real-time flap perfusion assessment. Baseline data, information of mastectomy and adjuvant therapy, surgical details, and follow-up records were reviewed and collected for statistical analysis.Results:A total of 31 patients were enrolled, with years of 43.0 on average (range, 30 to 55). Among them 16 patients received radiotherapy (51.6%), 9 patients had lower abdominal scars due to previous surgery (29.0%), 2 patients had body mass index (BMI) lower than 20 kg/m 2(6.5%). Measurements of flaps ranged from 20 cm×8 cm to 20 cm×38 cm. The operative time was 593±94 minutes. Of the 31 flaps enrolled, 24 were DIEP/DIEP flaps, 6 were DIEP/SIEA flaps, one was SIEA/SIEA flap. Intraflap anastomoses were performed in 6 flaps. The other 25 flaps were anastomosed to separate recipients. There was no flap loss encountered. Marginal necrosis of the flap happened in one patient, fat liquefaction of the donor site occurred in four patients, which was treated with conservative debridement. Patients were followed up for 13 months on average (range, 10 to 60 months). No long-term complication was observed during the follow-up. All patients reported satisfying aesthetic outcomes. Conclusions:Bipedicled DIEP flaps provide sufficient tissue quantity and reliable blood supply. Patients with severe breast deficiency, lacking lower abdominal fat, or having abdominal midline scars were appropriate to perform this type of flaps for delayed breast reconstruction.
