by Hembd, Austin;
Teotia, Sumeet S.; Zhu, Hong; Haddock, Nicholas T.
Background: This
study aims to elucidate the important predicting factors for fat necrosis and
abdominal morbidity in the patient undergoing deep inferior epigastric artery
perforator flap reconstruction.
Methods: The authors conducted a retrospective review of
866 free-flap breast reconstructions performed at one institution from 2010 to
2016. Twenty-eight potential predictors were included in multivariable analyses
to control for possible confounding interactions.
Results: Four
hundred nine total deep inferior epigastric artery perforator flaps were
included in the statistical analysis. Of these, 14.4 percent had flap fat
necrosis, 21.3 percent had an abdominal wound or complication, and 6 percent
had an abdominal bulge or hernia. Analysis showed an increase in the odds of
fat necrosis with increasing flap weight (OR, 1.002 per 1-g increase; p =
0.0002). A decrease in the odds of fat necrosis was seen with lateral row (OR,
0.29; p = 0.001) and both medial and lateral row perforator flaps (OR, 0.21; p
= 0.001), if indocyanine green angiography was used (OR, 0.46; p = 0.04), and
with increasing total flow rate of the flap (OR, 0.62 per 1-mm/second increase;
p = 0.05). Increased odds of abdominal bulge or hernia were seen with lateral
row or both medial and lateral row perforators (OR, 3.21; p = 0.05) versus
medial row perforator-based flaps, and with patients who had an abdominal wound
postoperatively (OR, 2.59; p = 0.05).
Conclusions: The
authors’ results suggest that using larger caliber perforators and perforators
from the lateral row alone, or in addition to medial row perforators, can
decrease fat necrosis more than simply harvesting more perforators alone.
However, lateral and both medial and lateral row perforator flaps come at the
cost of increasing abdominal bulge rates. CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
