Scars and perforator-based flaps in the abdominal region: a contraindication?

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Vascular Surgery

Background:

• Vertical midline scars from prior surgery pose challenges for autologous breast reconstruction.
• Limited research exists on abdominal wall vascular regeneration after vertical surgical approaches.

Purpose of the Study:

• To evaluate the feasibility and outcomes of autologous reconstruction in patients with vertical abdominal scars.
• To assess the impact of vertical scars on abdominal wall vascularity and flap viability.

Main Methods:

• Retrospective case series of 8 patients undergoing reconstruction (7 breast, 1 thigh).
• Utilized MS-2-vertical rectus abdominis myocutaneous (VRAM) and MS-2-transverse rectus abdominis myocutaneous (TRAM) free flaps for breast reconstruction.
• Transverse deep inferior epigastric perforator (DIEP) free flap used for thigh reconstruction.
• Clinical follow-up at 12 months post-operation.

Main Results:

• MS-2-VRAM free flaps yielded good aesthetic results in all 3 patients.
• Vertical midline scars did not negatively impact surgical outcomes, perfusion, or tissue viability in MS-2-TRAM and DIEP flaps.

Conclusions:

• The regenerative capacity of the abdominal wall's superficial vascular system with vertical scars is underestimated.
• MS-2-VRAM free flaps represent a viable and effective alternative for reconstruction in patients with vertical abdominal scars.