Time and Speed of Vascular Pedicle Dissection in Deep Inferior Epigastric Artery Perforator Flap Elevation

Abstract

Background Breast reconstruction using deep inferior epigastric artery perforator (DIEP) free flap is widely used because of the advantages of minimizing donor-site morbidity, but it requires technical competency in vascular dissection. This study evaluated the influence of patient factors and vascular status on the time and speed of dissection of the vascular pedicle.

Methods DIEP free flap procedures were performed in 49 patients assigned to immediate or delayed reconstruction groups. Factors that significantly influenced the time required and the speed of dissection were evaluated.

Results The average total dissection time was 55.9 minutes (34.5 minutes for the intramuscular dissection and 21.4 minutes for the submuscular dissection). The dissection speed for the total vascular pedicle was 2.65 cm/10 minutes (1.71 cm/10 minutes for the intramuscular dissection and 4.30 cm/10 minutes for the submuscular dissection). The presence of a Pfannenstiel scar, length of the vascular pedicle in the intramuscular area, and the number of microclips used significantly correlated with the total dissection time.

Conclusion The length of the intramuscular pedicle, number of microclips used, and presence of a Pfannenstiel scar significantly correlated with the total dissection time of the vascular pedicle. An assessment prior to the surgery can reduce the time of operation and make it easier to elevate the flap.

Keywords

autologous breast reconstruction - deep inferior epigastric artery perforator free flap - dissection of vascular pedicle - dissection time and speed

• References

• 1 Keller A. The deep inferior epigastric perforator free flap for breast reconstruction. Ann Plast Surg 2001; 46 (05) 474-479 , discussion 479–480
• 2 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (06) 645-648
• 3 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32 (01) 32-38
• 4 Rozen WM, Ashton MW, Pan WR, Taylor GI. Raising perforator flaps for breast reconstruction: the intramuscular anatomy of the deep inferior epigastric artery. Plast Reconstr Surg 2007; 120 (06) 1443-1449
• 5 Mahajan AL, Zeltzer A, Claes KE, Van Landuyt K, Hamdi M. Are Pfannenstiel scars a boon or a curse for DIEP flap breast reconstructions?. Plast Reconstr Surg 2012; 129 (04) 797-805
• 6 Laporta R, Longo B, Sorotos M, Santanelli di Pompeo F. Tips and tricks for DIEP flap breast reconstruction in patients with previous abdominal scar. Microsurgery 2015 (Epub ahead of print)
• 7 Park YJ, Kim EK, Yun JY, Eom JS, Lee TJ. The influence of pfannenstiel incision scarring on deep inferior epigastric perforator. Arch Plast Surg 2014; 41 (05) 542-547
• 8 Mani M, Wang T, Harris P, James S. Breast reconstruction with the deep inferior epigastric perforator flap is a reliable alternative in slim patients. Microsurgery 2016; 36 (07) 552-558
• 9 Heitmann C, Felmerer G, Durmus C, Matejic B, Ingianni G. Anatomical features of perforator blood vessels in the deep inferior epigastric perforator flap. Br J Plast Surg 2000; 53 (03) 205-208
• 10 Gill PS, Hunt JP, Guerra AB. , et al. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 2004; 113 (04) 1153-1160
• 11 Munhoz AM, Ishida LH, Sturtz GP. , et al. Importance of lateral row perforator vessels in deep inferior epigastric perforator flap harvesting. Plast Reconstr Surg 2004; 113 (02) 517-524
• 12 Vandevoort M, Vranckx JJ, Fabre G. Perforator topography of the deep inferior epigastric perforator flap in 100 cases of breast reconstruction. Plast Reconstr Surg 2002; 109 (06) 1912-1918
• 13 Rozen WM, Phillips TJ, Ashton MW, Stella DL, Taylor GI. A new preoperative imaging modality for free flaps in breast reconstruction: computed tomographic angiography. Plast Reconstr Surg 2008; 122 (01) 38e-40e