Process of Improvement in Limiting Abdominal Wall Morbidity Following Deep Inferior Epigastric Perforator Flap
Min-Jeong Cho, Austin Hembd, M.D., Avinash Jayaraman, BS, Catherine Sobieski, Connie Ma, Nicholas T. Haddock, Sumeet S. Teotia.
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Deep inferior epigastric perforator flap (DIEP) is the workhorse flap for autologous breast reconstruction. Given its popularity, many surgeons have become facile in performing DIEP with a minimal flap failure rate. However, minimizing donor site morbidity remains a challenge. At our institution, we have created a seven-step model to limit abdominal wall morbidity following DIEP flap harvest. In this study, we present our early experience utilizing this model.
We performed a prospective study using a seven-step model to minimize abdominal morbidity in patients undergoing DIEP flaps: 1) limited central subscarpa excision; 2) triple point umbilicus inset; 3) remnant abdominal flap perforator preservation; 4) limited central abdomen flap elevation to the subcostal margin; 5) abdominal washout with a saline; 6) SPY technology to evaluate the abdominal flap and umbilicus; and 7) umbilical excision in appropriate candidates. All patients underwent preoperative computed tomography of the abdomen, and we used our previously published criteria to determine suitable candidates for possible umbilical excision (umbilical stalk length >4cm, or BMI>40).
All reconstructions were performed by the two senior authors, and faculty performed our seven-step abdominal closure protocol. Of the 22 patients that underwent this protocol, only 1 patient (4.5%) experienced a wound complication, which is lower than the published rate of 20-30%. There were no other donor site complications such as seroma, or hematoma. Two patients underwent intraoperative umbilical excision per criteria, and there were no flap losses.
CONCLUSION: In conclusion, we share our experience using the seven-step model to minimize abdominal wall morbidity following deep inferior epigastric perforator flaps. By evaluating the process of abdominal closure and creating a simple seven-step procedure we have shown a decreased morbidity rate. We believe this model provides efficiency, reproducibility, and improved outcomes.
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