J reconstr Microsurg 2019; 35(06): 411-416
DOI: 10.1055/s-0038-1677013
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The “Dual-Plane” DIEP Flap: Measuring the Effects of Superficial Arterial and Venous Flow Augmentation on Clinical Outcomes

Hani Sbitany
1  Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California
,
Rachel Lentz
1  Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California
,
Merisa Piper
1  Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California
› Author Affiliations
Funding No funding was provided for the data collection or writing of this manuscript.
Further Information

Publication History

22 July 2018

11 November 2018

Publication Date:
07 January 2019 (eFirst)

Abstract

Background Deep inferior epigastric perforator (DIEP) flaps are routinely elevated on a single dominant perforator from the deep epigastric vascular system. However, the single perforator may not always perfuse an entire flap adequately, particularly suprascarpal tissue. We often perform “dual-plane” single perforator DIEP flaps by rerouting the superficial (SIEA/V) system directly into a branch of the deep (DIEA/V) vascular system pedicle, thus allowing both systems to contribute and enhance flap perfusion.

Methods A prospectively collected database of patients undergoing microvascular breast reconstruction was reviewed for patients undergoing “dual-plane” DIEP flaps. These were matched to a similar cohort of patients undergoing “traditional” single perforator DIEP free flaps over the same time period. Treatment demographics and flap-specific morbidity outcomes were assessed, including performance in the setting of radiation.

Results Over 2 years, 23 “dual-plane” DIEP flaps were performed (15 patients), compared with 35 single-perforator “traditional” DIEP flaps (23 patients). Rates of delayed healing were similar between both cohorts (2.9 vs. 4.3%, p = 0.28). Rates of palpable fat necrosis were significantly lower in “dual-plane” DIEP flaps compared with “traditional” flaps (0 vs. 14.3%, p = 0.03). Rates of clinically palpable fat necrosis following radiation were significantly lower in the “dual-plane” flaps (4.3 vs. 40%, p = 0.02).

Conclusion The “dual-plane” DIEP flap is one we routinely consider in our algorithm, as it allows for full preservation of functional abdominal musculature, and offers enhanced flap perfusion by incorporating both the deep and superficial (dominant) vascular systems. This results in lower fat necrosis rates, particularly in the setting of post-reconstruction radiation.

Note

This study was presented at the American Society of Reconstructive Microsurgery (ASRM) Annual Meeting. Scottsdale, Arizona. January 2016.


Financial Disclosures

None of the authors have any disclosures related to the content of this manuscript.


Study Classification

Case-Control.


Author Contribution

Dr. Hani Sbitany: Study idea conception, study design, data collection, surgical case collection, and writing of manuscript.


Dr. Rachel Lentz: Study idea conception, study design, and review of manuscript.


Dr. Merisa Piper: Study idea conception, study design, and writing of manuscript.