Early Experience with Mesh Suture for DIEP Flap Abdominal Site Closures

Area of Science:

• Microsurgery
• Plastic Surgery
• Abdominal Wall Reconstruction

Background:

• Deep inferior epigastric perforator (DIEP) free flap is the gold standard for microsurgical breast reconstruction.
• DIEP flaps have reduced morbidity compared to TRAM and muscle-sparing TRAM flaps.
• Abdominal wall complications, including bulges (up to 33%), persist after DIEP flap surgery.

Purpose of the Study:

• To evaluate the efficacy of Duramesh mesh suture in minimizing abdominal wall complications following DIEP flap surgery.
• To assess the safety and feasibility of using Duramesh in DIEP flap procedures.

Main Methods:

• Retrospective review of the first 25 patients undergoing DIEP flap surgery with Duramesh mesh.
• Analysis of surgical details and outcomes including surgical site infections, events, incisional hernias, and bulges.
• Descriptive statistics used for patient characteristics and outcomes.

Main Results:

• Out of 25 patients, one (4%) developed a surgical site infection and four (16%) had surgical site events.
• One patient (4%) experienced a bulge, and no incisional hernias were observed.
• Average follow-up was 216 days.

Conclusions:

• Duramesh mesh suture offers a potential solution to reduce abdominal wall morbidity and mesh-related issues in DIEP flap surgery.
• It can be used for primary closure of the anterior rectus sheath, providing force distribution benefits.
• Duramesh appears to be a safe and simple alternative technique for microsurgeons to decrease fascial dehiscence, bulges, and hernias.