Open Access
CC BY 4.0 · Arch Plast Surg 2023; 50(06): 586-592
DOI: 10.1055/a-1976-2212
Extremity/Lymphedema
Original Article

Surgical Considerations of One-Stage Reconstruction of Large Extremity Defects Using a Thin Deep Inferior Epigastric Perforator Flap

Seung Yeol Lee 
1   Department of Orthopedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi, Korea
,
Moon Chul Seok 
1   Department of Orthopedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi, Korea
,
Bo Young Park 
2   Department of Plastic and Reconstructive Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
› Author Affiliations
Funding This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (2019R1A2C2010150) and National Research Foundation of Korea (NRF) grant funded by the Korean Government (MSIT) NRF-2022R1F1A1076330.
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Abstract

Background One-stage reconstruction with “thin perforator flaps” has been attempted to salvage limbs and restore function. The deep inferior epigastric perforator (DIEP) flap is a commonly utilized flap in breast reconstruction (BR). The purpose of this study is to present the versatility of DIEP flaps for the reconstruction of large defects of the extremities.

Methods Patients with large tissue defects on extremities who were treated with thin DIEP flaps from January 2016 to January 2018 were included. They were minimally followed up for 36 months. We analyzed the etiology and location of the soft tissue defect, flap design, anastomosis type, outcome, and complications. We also considered the technical differences in the DIEP flap between breast and extremity reconstruction.

Results Overall, six free DIEP flaps were included in the study. The flap size ranged from 15 × 12 to 30 × 16 cm2. All flaps were transversely designed similar to a traditional BR design. Three flaps were elevated with two perforators. Primary closure of the donor site was possible in all cases. Five flaps survived with no complications. However, partial necrosis occurred in one flap.

Conclusion A DIEP flap is not the first choice for soft tissue defects, but it should be considered for one-stage reconstruction of large defects when the circulation zone of the DIEP flap is considered. In addition, this flap has many advantages over other flaps such as provision of the largest skin paddle, low donor site morbidity with a concealed scar, versatile supercharging technique, and a long pedicle.

Keywords

perforator flap - large defect reconstruction - deep inferior epigastric perforator flap

Note

This study was presented at the 10th Congress of World Society for Reconstructive Microsurgery.


Author Contribution

Conceptualization: B.Y.P. Data curation: B.Y.P. Formal analysis: M.C.S. Methodology: S.Y.L. Writing - original draft: B.Y.P. Writing - review & editing: B.Y.P.


Ethical Approval

The study was approved by the institutional ethics committee of the Ewha Womans University Seoul Hospital (2021-07-039).


Patient Consent

Written informed patient consent obtained for the study.




Publication History

Received: 01 November 2022

Accepted: 02 November 2022

Accepted Manuscript online:
10 November 2022

Article published online:
01 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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