Evidence-based Algorithms for Free Deep Inferior Epigastric Perforator Flap Salvage in Autologous Breast...

Area of Science:

• Plastic Surgery
• Microsurgery
• Breast Reconstruction

Background:

• Deep inferior epigastric perforator (DIEP) free flap is the gold standard for autologous breast reconstruction.
• Flap take-back to the operating room (OR) for DIEP flap compromise is uncommon but challenging.
• Prompt and accessible resources are crucial for managing DIEP flap compromise.

Purpose of the Study:

• To develop evidence-based perioperative algorithms for managing DIEP flap compromise.
• To provide a structured approach for optimizing patient care and facilitating return to the OR.
• To create readily available resources for surgeons managing flap emergencies.

Main Methods:

• Conducted a comprehensive literature review (MEDLINE, Embase, Google Scholar, Cochrane).
• Developed evidence-based clinical algorithms based on reviewed publications.
• Underwent expert review and revision by 6 international microsurgery specialists.

Main Results:

• Created three distinct evidence-based management algorithms for DIEP flap compromise.
• Algorithm 1 details perioperative strategies, including flap inset, salvage, and postoperative management.
• Algorithms 2 and 3 provide specific intraoperative strategies for venous congestion and vascular thrombosis, respectively.

Conclusions:

• Developed a coherent, stepwise approach to DIEP flap compromise in breast reconstruction.
• Expert-reviewed algorithms offer an approachable and evidence-based structure for managing flap emergencies.
• These algorithms serve as valuable, readily accessible resources for surgical teams.