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SIEA versus DIEP Arterial Complications: A Cohort Study.
Christopher J Coroneos1, Adrian M Heller, Sophocles H Voineskos
1Hamilton, Ontario, Canada From the Division of Plastic Surgery, Department of Surgery, McMaster University.
Plastic and Reconstructive Surgery
|April 29, 2015
Summary
Superficial inferior epigastric artery (SIEA) flaps for breast reconstruction led to significantly more arterial complications and failures compared to deep inferior epigastric artery perforator (DIEP) flaps. These findings indicate SIEA flaps are less reliable for this procedure.
Area of Science:
- Plastic Surgery
- Microsurgery
- Breast Reconstruction
Background:
- Superficial inferior epigastric artery (SIEA) flaps have limitations including variability, caliber, and angiosome, often requiring preoperative imaging for patient selection.
- Current expert practice typically limits SIEA flap use to cases with favorable arterial anatomy identified on preoperative imaging.
Purpose of the Study:
- To compare arterial complications in patients undergoing breast reconstruction using SIEA flaps versus deep inferior epigastric artery perforator (DIEP) flaps.
- To evaluate the outcomes of SIEA flaps in breast reconstruction without the use of preoperative imaging.
Main Methods:
- A retrospective cohort study reviewed 169 free flaps (44 SIEA, 125 DIEP) performed between 2007 and 2013 by a single microsurgeon.
- Preoperative imaging was not utilized; intraoperative criteria guided SIEA flap selection.
- Complications were independently abstracted in duplicate using standardized forms and a priori criteria.
Main Results:
- SIEA flaps had significantly higher rates of reexploration (20% vs. 7%), arterial insufficiency (14% vs. 1%), and necrosis requiring intervention compared to DIEP flaps.
- Complete flap failure was significantly higher in SIEA flaps (14% vs. 2%), exclusively due to arterial thrombosis.
- No significant difference in venous insufficiency was observed between SIEA and DIEP flaps (p=0.92).
Conclusions:
- SIEA flaps demonstrated significantly higher rates of reexploration, arterial complications, necrosis, and complete failure compared to DIEP flaps.
- Arterial thrombosis was the primary cause of SIEA flap failures.
- The study concluded that SIEA flaps are less reliable for breast reconstruction than DIEP flaps, leading to their discontinuation in the authors' practice.
