Neck burn scar reconstruction with the rectus fascia-sparing DIEP flap: A case report

Massive soft tissue defects resulting from burn injuries to the neck present significant challenges for surgical intervention. Free flaps are generally regarded as the preferred approach because they provide reliable coverage for soft tissue defects. Among these options, the deep inferior epigastric perforator (DIEP) flap is particularly beneficial, especially for middle-aged women, as it offers a substantial volume of tissue while allowing for an abdominoplasty at the donor site.

This article presents a case of complex neck scar reconstruction using the DIEP flap, highlighting immediate flap thinning and the flap extension based on the hypothesis of a vascular plexus connection between the two perforators on each side of the flap.

The findings show that the flap can be effectively extended for reconstruction purposes without the need to anastomose the two pedicles. The flap exhibited adequate vascularization, and no complications were observed. By preserving the anterior fascia between the two perforators, it is possible to enhance the vascularity of the DIEP flap, making it a suitable reconstructive option that not only provides a significant amount of soft tissue but also ensures an optimal blood supply. Following a single debulking procedure, the flap and the donor site exhibited favorable cosmetic outcomes six years post-surgery.

Using a rectus fascial-sparing DIEP flap may serve as a viable option that conserves area IV of the flap while simultaneously reducing the morbidity associated with the donor site.