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Related Experiment Video

Updated: May 23, 2025

In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury
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Novel Windmill Nonischemic Free Bilateral Deep Inferior Epigastric Perforator Flap for Extensive Defect

Matthew H Loper1, Collin E Gonce1, Dakota St Pierre1

  • 1From the Division of Plastic and Reconstructive Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK.

Plastic and Reconstructive Surgery. Global Open
|March 7, 2025
PubMed
Summary

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This study introduces a novel windmill nonischemic free bilateral deep inferior epigastric perforator (DIEP) flap for reconstructing large lower extremity defects. This technique offers a single-stage solution with no ischemia time, minimizing complications.

Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Microsurgery

Background:

  • Reconstructing extensive lower extremity soft tissue defects is challenging.
  • Finding suitable donor sites that minimize morbidity is difficult.
  • Existing methods often involve multiple stages or ischemia time.

Purpose of the Study:

  • To describe a novel windmill nonischemic free bilateral deep inferior epigastric perforator (DIEP) flap.
  • To evaluate its suitability for extensive lower extremity defect reconstruction.
  • To present a case study of its successful application.

Main Methods:

  • A windmill nonischemic free bilateral deep inferior epigastric perforator (DIEP) flap was designed and harvested.
  • The flap was used to reconstruct a 65 × 25 cm lower extremity defect.

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  • Dual pedicles with proximal and distal anastomoses were utilized for perfusion, ensuring no ischemia time.

    • Main Results:

    • A large bilateral DIEP flap (70 × 21 cm) successfully covered the massive defect.
    • Perfusion was achieved outside the zone of injury.
    • No postoperative complications were observed during a 2.25-year follow-up.

    Conclusions:

    • The windmill nonischemic free bilateral DIEP flap is a viable and effective option for single-stage reconstruction of extensive lower extremity defects.
    • This technique provides adequate surface area coverage while minimizing donor-site morbidity and eliminating ischemia time.
    • It represents a significant advancement in reconstructive microsurgery for complex limb injuries.