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Comparison of abdominal wall morbidity between medial and lateral row-based deep inferior epigastric perforator flap
Hirokazu Uda1, Yoko Katsuragi Tomioka1, Syunji Sarukawa1
1Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
Introduction:
Although deep inferior epigastric perforator (DIEP) flap is associated with decreased abdominal morbidity, motor nerve damage during flap elevation cannot be ignored. We compared abdominal morbidity after elevation of DIEP flap with lateral row perforators (L-DIEP) and medial row perforators (M-DIEP) to determine the perforators associated with less abdominal morbidity.
Methods:
Women who underwent breast reconstruction with DIEP flaps (n = 49) were included in this study. Among them, M-DIEP and L-DIEP were harvested in 27 and 22 patients, respectively. Pre- and postoperative trunk flexor muscle ability (at 3 and 6 months after surgery) was measured prospectively in all patients using an isokinetic dynamometer. The patients were also investigated for postoperative pain, stiffness, activity, bulging, and lumbago.
Results:
At 3 months after surgery, a significant decrease in trunk flexor muscle ability was observed in the patients of the L-DIEP group, but they recovered well after further 3 months. However, the recovery tended to be weak. Similar results were obtained with respect to pain, stiffness, activity, bulging, and lumbago between the two groups at 6 months after surgery.
Conclusions:
Dominant perforators for DIEP flap elevation should be chosen by considering flap viability. However, surgeons should be aware that elevation with L-DIEP is associated with a high risk of nerve injury, and may in turn result in short-term decreases in trunk flexor muscle ability. Therefore, precautionary methods should be taken by the surgeons to preserve the motor nerve with atraumatic dissection, especially during elevation with L-DIEP.
Insights
Deep inferior epigastric perforator (DIEP) flap surgery can cause motor nerve damage. Lateral row DIEP flaps (L-DIEP) may lead to temporary trunk muscle weakness, highlighting the need for careful surgical technique.
Area of Science:
- Plastic Surgery
- Microsurgery
- Breast Reconstruction
Background:
- Deep inferior epigastric perforator (DIEP) flap surgery is a common breast reconstruction technique.
- While associated with reduced abdominal morbidity, potential motor nerve damage during flap elevation requires consideration.
- Comparing perforator harvest sites is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare abdominal morbidity between DIEP flaps raised from lateral row perforators (L-DIEP) and medial row perforators (M-DIEP).
- To evaluate the impact of perforator choice on motor nerve function and associated symptoms.
Main Methods:
- Prospective study of 49 women undergoing DIEP flap breast reconstruction.
- Patients were divided into L-DIEP (n=22) and M-DIEP (n=27) groups.
- Trunk flexor muscle strength, pain, stiffness, activity, bulging, and lumbago were assessed pre- and post-operatively at 3 and 6 months.
Main Results:
- A significant, albeit temporary, decrease in trunk flexor muscle strength was noted in the L-DIEP group at 3 months post-surgery.
- While recovery occurred by 6 months, it tended to be less robust in the L-DIEP group.
- No significant differences in pain, stiffness, activity, bulging, or lumbago were observed between the L-DIEP and M-DIEP groups at 6 months.
Conclusions:
- Elevation of DIEP flaps using lateral row perforators (L-DIEP) carries a higher risk of motor nerve injury.
- This nerve injury can lead to short-term deficits in trunk flexor muscle strength.
- Surgeons should prioritize nerve preservation techniques, particularly during L-DIEP flap elevation, to minimize abdominal morbidity.
