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Related Experiment Video

Updated: Apr 30, 2026

An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
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DIEP flap sentinel skin paddle positioning algorithm.

Rosaria Laporta1, Benedetto Longo, Michail Sorotos

  • 1Plastic Surgery Department, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome, Italy.

Microsurgery
|April 29, 2014
PubMed
Summary
This summary is machine-generated.

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A new algorithm for sentinel skin paddle (SSP) positioning in deep inferior epigastric perforator (DIEP) flaps aids in monitoring buried flaps. This method allows for early detection of perfusion issues and successful flap salvage without expensive additional tests.

Area of Science:

  • Plastic Surgery
  • Microsurgery
  • Breast Reconstruction

Background:

  • Clinical examination is the standard for flap monitoring but is challenging for buried free-tissue transfers.
  • Deep inferior epigastric perforator (DIEP) flaps are commonly used in breast reconstruction.
  • Effective monitoring of buried DIEP flaps is crucial for successful outcomes.

Purpose of the Study:

  • To present a sentinel skin paddle (SSP) positioning algorithm for DIEP flaps.
  • To investigate the reliability of the SSP algorithm in monitoring buried flaps.
  • To evaluate the impact of SSP positioning on flap monitoring and salvage rates.

Main Methods:

  • A standardized protocol for SSP positioning was developed based on mastectomy incision types.
  • Three hundred forty-seven DIEP flap breast reconstructions were reviewed and categorized by skin paddle (SP) type.

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  • Flaps were monitored using hand-held Doppler and clinical observation; take-back for pedicle compromise was recorded.

    • Main Results:

    • Sixteen flaps (4.6%) required reoperation for pedicle compromise, with 13 (81.25%) successfully salvaged.
    • No statistically significant difference was found in microvascular complication rates between large SPs and SSPs (P=0.108).
    • Flap salvage rates were independent of SP type (P=0.473).

    Conclusions:

    • The SSP positioning algorithm enables reliable monitoring of buried DIEP flaps.
    • Early detection of perfusion impairment and successful flap salvage can be achieved with SSP.
    • This method obviates the need for adjunctive, costly monitoring tests in DIEP flap breast reconstruction.