Evaluation of free DIEP flap complications in the setting of previous gynecological operations

Autologous tissue breast reconstruction with free deep inferior epigastric perforator (DIEP) flaps is reliable with reproducible results and very few contraindications. However, previous surgery may compromise the abdominal donor site due to injury to the vascular pedicle. The purpose of the current study is to evaluate the effects of prior abdominal surgery on need for changes to the operative plan, intraoperative complications, and postoperative flap compromise.

A retrospective review of all patients undergoing breast reconstruction with free tissue transfer from the abdomen was performed.

A total of 733 free abdominal flaps were performed in 478 patients during the study period. Two hundred sixty-two (54.8%) patients had prior abdominal surgery with 24.8% laparoscopic/robotic versus 56.9% open versus 18.3% both, 21.4% general surgery versus 60.7% gynecological versus 17.9% both, and 97.7% elective versus 1.1% emergent versus 1.1% both. There were 15 total flap losses (2.0%) and 2 partial flap losses (0.3%). Intraoperative complications and changes in the operative plan occurred in 13 flaps (1.8%) with 84.6% having prior gynecological surgery (p = .0001).

Free DIEP flap breast reconstruction is becoming more commonplace with a low risk of complications. Although DIEP flaps are still possible in the setting of prior abdominal surgery, there is a higher risk of damage to the deep inferior epigastric pedicle in patients who have had emergency Cesarean sections or hysterectomy. Conducting a focused history may prepare the reconstructive microsurgeon to address and to avoid potential intraoperative complications.