Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient Vessels
Background The aim of this study is to analyze the impact of the number and location of perforators harvested and the recipient vessels used on deep inferior epigastric perforator (DIEP) flap survival and the occurrence of flap necrosis requiring re-operation. Patients and Methods Four hu...
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| Format: | Article |
| Language: | English |
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Georg Thieme Verlag KG
2021-01-01
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| Series: | Journal of Reconstructive Microsurgery Open |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1729638 |
| _version_ | 1818898123081121792 |
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| author | Johanna S. Palve Tiina H. Luukkaala Minna T. Kääriäinen |
| author_facet | Johanna S. Palve Tiina H. Luukkaala Minna T. Kääriäinen |
| author_sort | Johanna S. Palve |
| collection | DOAJ |
| description | Background The aim of this study is to analyze the impact of the number and location of perforators harvested and the recipient vessels used on deep inferior epigastric perforator (DIEP) flap survival and the occurrence of flap necrosis requiring re-operation.
Patients and Methods Four hundred and seventy-one DIEP flap reconstructions, performed between January 2008 and December 2019, were retrospectively analyzed.
Results Flap necrosis requiring re-operation was observed in 40 (9%) of flaps and total flap loss rate was 1% (n = 6). No significant differences were observed between internal mammary vessels (IMV, n = 287, 61%) and thoracodorsal vessels (TDV, n = 184, 39%) regarding postoperative re-anastomosis (p = 0.529) or flap survival (p = 0.646). Intraoperative conversion from IMV to TDV was performed on 64 (14%) patients. TDV were more commonly associated with problems in preparation of the vessels than IMV (p < 0.001). Second vein anastomosis was performed on 18 (4%) patients. In total, 81 flaps (17%) had one perforator, 165 (35%) had two, 218 (46%) had three to five, and 7 (2%) had more than five perforators. Flaps with three to five perforators were more commonly associated with flap necrosis (p < 0.001) than flaps with one or two perforators. Independent factors associated with necrosis were body mass index (BMI) > 30 (odds ratio [OR]: 2.28; 95% confidence interval: 1.06–4.91, p = 0.035) and perforator/s located on the lateral row (OR: 3.08, 95% CI 1.29–7.33, p = 0.011).
Conclusion We conclude that the occurrence of flap necrosis requiring re-operation may be higher in DIEP flaps with more than two perforators or perforator/s located on the lateral row and in obese patients. Neither the recipient vessels used nor the number of perforators harvested had any impact on the flap survival rate. |
| first_indexed | 2024-12-19T19:27:04Z |
| format | Article |
| id | doaj.art-f9f8c236754142b0ad1a9219a3320f1a |
| institution | Directory Open Access Journal |
| issn | 2377-0813 2377-0821 |
| language | English |
| last_indexed | 2024-12-19T19:27:04Z |
| publishDate | 2021-01-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Journal of Reconstructive Microsurgery Open |
| spelling | doaj.art-f9f8c236754142b0ad1a9219a3320f1a2022-12-21T20:08:45ZengGeorg Thieme Verlag KGJournal of Reconstructive Microsurgery Open2377-08132377-08212021-01-010601e20e2710.1055/s-0041-1729638Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient VesselsJohanna S. Palve0Tiina H. Luukkaala1Minna T. Kääriäinen2Department of Plastic Surgery, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, FinlandResearch, Development and Innovation Center, Tampere University Hospital and Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, FinlandDepartment of Plastic Surgery, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, FinlandBackground The aim of this study is to analyze the impact of the number and location of perforators harvested and the recipient vessels used on deep inferior epigastric perforator (DIEP) flap survival and the occurrence of flap necrosis requiring re-operation. Patients and Methods Four hundred and seventy-one DIEP flap reconstructions, performed between January 2008 and December 2019, were retrospectively analyzed. Results Flap necrosis requiring re-operation was observed in 40 (9%) of flaps and total flap loss rate was 1% (n = 6). No significant differences were observed between internal mammary vessels (IMV, n = 287, 61%) and thoracodorsal vessels (TDV, n = 184, 39%) regarding postoperative re-anastomosis (p = 0.529) or flap survival (p = 0.646). Intraoperative conversion from IMV to TDV was performed on 64 (14%) patients. TDV were more commonly associated with problems in preparation of the vessels than IMV (p < 0.001). Second vein anastomosis was performed on 18 (4%) patients. In total, 81 flaps (17%) had one perforator, 165 (35%) had two, 218 (46%) had three to five, and 7 (2%) had more than five perforators. Flaps with three to five perforators were more commonly associated with flap necrosis (p < 0.001) than flaps with one or two perforators. Independent factors associated with necrosis were body mass index (BMI) > 30 (odds ratio [OR]: 2.28; 95% confidence interval: 1.06–4.91, p = 0.035) and perforator/s located on the lateral row (OR: 3.08, 95% CI 1.29–7.33, p = 0.011). Conclusion We conclude that the occurrence of flap necrosis requiring re-operation may be higher in DIEP flaps with more than two perforators or perforator/s located on the lateral row and in obese patients. Neither the recipient vessels used nor the number of perforators harvested had any impact on the flap survival rate.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1729638deep inferior epigastric perforatorperforatorrecipient vesselflap necrosis |
| spellingShingle | Johanna S. Palve Tiina H. Luukkaala Minna T. Kääriäinen Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient Vessels Journal of Reconstructive Microsurgery Open deep inferior epigastric perforator perforator recipient vessel flap necrosis |
| title | Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient Vessels |
| title_full | Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient Vessels |
| title_fullStr | Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient Vessels |
| title_full_unstemmed | Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient Vessels |
| title_short | Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient Vessels |
| title_sort | necrosis or flap loss after deep inferior epigastric perforator reconstruction impact of perforators and recipient vessels |
| topic | deep inferior epigastric perforator perforator recipient vessel flap necrosis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1729638 |
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