A decision-making algorithm for recipient vein selection in bipedicle deep inferior epigastric artery perforator flap...

The bipedicle deep inferior epigastric artery perforator (DIEP) flap allows reliable transfer of the entire lower abdominal flap in patients who have a small pannus or require a large volume breast reconstruction. Selection of recipient vessels for the second pedicle can however, be challenging. We describe our experience with a consecutive series of twenty three bipedicle DIEP flaps with particular focus on selection of the recipient veins. We demonstrate that with judicious selection the internal mammary system can be reliably used as recipients for both pedicles with low complication rates.