Related Experiment Video
Updated: Oct 10, 2025
The Superficial Inferior Epigastric Artery Axial Flap to Study Ischemic Preconditioning Effects in a Rat Model
Published on: January 27, 2023
Limiting the fascia incision length in a DIEP flap: Repercussion on abdominal wall morbidity
Paulien H Hilven1, Marc Vandevoort2, Frans Bruyninckx3
1Department of Plastic and Reconstructive Surgery; University Hospitals Leuven; Belgium.
Background:
The evolution from free muscle-sparing transverse rectus abdominis myocutaneous flap to deep inferior epigastric perforator (DIEP) flap leads to less donor-site morbidity. However, rectus fascia is usually incised longitudinally from perforator(s) to iliac vessels, often exceeding 15 cm when including longitudinal muscle spreading. By using a limited fascia incisional (LFI-) technique, we try to diminish abdominal wall functional decrease.
Methods:
Twenty-seven patients who underwent unilateral breast reconstructions using free DIEP-flap with limited fascia incision between December 2014 and October 2017 were included in the study. Each patient received a periumbilical electromyogram (EMG) preoperatively, at 6 and 14 weeks postoperatively. They were compared with 27 patients having unilateral breast reconstructions using classic free DIEP-flap, performed at the same department between November 2009 and May 2011.
Results:
In our LFI-technique, one vertical (4 cm) incision is made where the pedicle exits the muscle. A second, oblique (3 cm) incision is made more distally where the pedicle runs into the iliac vessels. After release, the pedicle is tunneled through the incisions, leaving all fascia, and therefore muscle, intact. In the LFI-group small neurogenic changes were noticed in only 26% and 11% of the patients at, respectively, 6 and 14 weeks postoperatively. By contrast, in the control group, postoperative neurogenic deviations remained in 37% of the patients at 14 weeks postoperatively; significant different compared to the LFI-group.
Conclusion:
This study shows the importance of preserving anterior rectus fascia. Nerve supply and abdominal rectus muscle function are less endangered using small segmental fascia incisions. We believe that our technique diminishes donor-site morbidity significantly and improves the postoperative recovery.
Insights
A new limited fascia incision technique for deep inferior epigastric perforator (DIEP) flaps significantly reduces abdominal wall dysfunction. This method preserves rectus fascia, improving patient recovery after breast reconstruction.
Area of Science:
- Microsurgery
- Plastic Surgery
- Abdominal Wall Reconstruction
Background:
- Deep inferior epigastric perforator (DIEP) flap breast reconstruction evolved from muscle-sparing techniques to minimize donor-site morbidity.
- Traditional DIEP flaps often require extensive rectus fascia incisions, potentially compromising abdominal wall function.
- The limited fascia incision (LFI) technique aims to reduce this functional deficit.
Purpose of the Study:
- To evaluate the impact of a novel limited fascia incision (LFI) technique on abdominal wall function following DIEP flap breast reconstruction.
- To compare postoperative neurogenic changes and functional recovery between LFI and classic DIEP flap techniques.
Main Methods:
- A prospective study included 27 patients undergoing unilateral breast reconstruction with LFI-DIEP flaps.
- Electromyography (EMG) assessed abdominal rectus muscle function preoperatively and at 6 and 14 weeks postoperatively.
- Results were compared to a control group of 27 patients who had undergone classic DIEP flap reconstruction.
Main Results:
- The LFI group showed significantly lower rates of neurogenic changes at 14 weeks postoperatively (11%) compared to the control group (37%).
- Incisions in the LFI technique were limited to 4 cm and 3 cm, preserving more rectus fascia.
- Preservation of fascia in the LFI technique led to less endangered nerve supply and muscle function.
Conclusions:
- Preserving anterior rectus fascia through limited incisions is crucial for maintaining abdominal wall function after DIEP flaps.
- The LFI technique significantly reduces donor-site morbidity and enhances postoperative recovery in breast reconstruction.
- This approach offers a promising method to improve functional outcomes in DIEP flap surgery.
