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Omission Of Superficial Fascial System: A Retrospective Chart Review And Grading Of Abdominal Donor Sites Postoperatively
Ariel C. Johnson, BS1, Becky BT King, MD2, Salih Colakoglu, MD1, Tae W. Chong, MD1, David W. Mathes, MD1.
1University of Colorado, Denver, CO, USA, 2University of Colorado, Aurora, CO, USA.

PURPOSE: Deep inferior epigastric artery perforator (DIEP) flap has become the preferred autologous reconstruction in patients after mastectomy. The superficial fascial system is routinely closed to alleviate tension on the overlying skin of the abdominal donor site. However, there has been no comparative analysis on closure of the superficial fascial system (SFS) and its effect on donor site outcomes. In this retrospective review, we assessed the incidence of wound dehiscence at the abdominal donor site in patients with SFS closure and no closure. Additionally, we asked surgeons to grade the scars and contour of the abdomen postoperatively to decipher if there is a difference in aesthetic outcome between the two groups.
METHODS: The authors evaluated outcomes of DIEP flap based breast reconstructions performed between 2017 to 2019, retrospectively. Patient demographics and abdominal site comorbidities were recorded. Board-certified plastic surgeons were then asked to grade scar and abdominal contour of the patients in both groups using previously published grading scales. Surgeons were blinded to patient groups.
RESULTS: The DIEP flap reconstruction was performed in 112 consecutive women. Among the patients with abdominal donor site reconstruction, 67 had total SFS closure and 45 did not. There was no significant difference in wound dehiscence rates between the two groups. There was no difference in patient scar and contour scale as well.
CONCLUSION: Omission of SFS closure resulted in no difference in wound dehiscence and aesthetic outcomes of the abdomen after abdominal flap reconstructive surgery.


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