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Deep Inferior Epigastric Perforator Versus Free Transverse Rectus Abdominis Myocutaneous Flap: Complications and
Yasmina Zoghbi1, David J Gerth, Jun Tashiro
1From the Division of Plastic, Aesthetic, & Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard Miller School of Medicine, Miami, FL.
Annals of Plastic Surgery
|January 5, 2017
Summary
Deep inferior epigastric perforator (DIEP) flaps reduce surgical site complications and hospital stays compared to free transverse rectus abdominis myocutaneous (fTRAM) flaps, though DIEP flaps incur higher total charges.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Surgical Outcomes Research
Background:
- Abdominal-based breast reconstruction encompasses a spectrum from pedicled TRAM to DIEP flaps.
- DIEP flaps offer rectus abdominis muscle sparing, potentially reducing donor site morbidity.
- This study compares postoperative outcomes of DIEP versus fTRAM flaps.
Purpose of the Study:
- To evaluate the impact of surgical advantages of DIEP flaps on postoperative outcomes compared to fTRAM flaps.
- To identify risk factors for increased length of stay and total charges.
- To compare surgical site complications between DIEP and fTRAM breast reconstruction.
Main Methods:
- Analysis of the Nationwide Inpatient Sample database (2010-2011) for DIEP and fTRAM breast reconstructions.
- Inclusion criteria: female patients undergoing total breast reconstruction; exclusion: male patients.
- Examination of demographic data, comorbidities, complications, length of stay, and total charges, with bivariate and multivariate analyses.
Main Results:
- The fTRAM cohort experienced higher rates of pneumonia, wound infection, and wound dehiscence.
- No significant differences were observed in revision rates, hemorrhage, hematoma, seroma, or flap loss.
- DIEP flaps were associated with higher total charges, while fTRAM flaps correlated with increased length of stay.
Conclusions:
- Free TRAM flaps are linked to increased surgical site complications and longer hospital stays.
- Deep inferior epigastric perforator flaps result in higher total charges.
- Overall postoperative complication rates did not significantly differ between the two flap types.
