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Related Concept Videos

Flail Chest-II01:26

Flail Chest-II

Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:

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Related Experiment Video

Updated: Jul 1, 2026

Engineered Vascularized Muscle Flap
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A single-operator technique for DIEP flap raise in high-BMI patients.

I Ibrahim1, X Chalhoub1, F P Henry1

  • 1Department of Plastic and Reconstructive Surgery, Charing Cross Hospital, Imperial College NHS Trust, London, UK.

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|January 11, 2026
PubMed
Summary

A novel surgical technique simplifies deep inferior epigastric perforator (DIEP) flap harvest for high body mass index (BMI) patients undergoing breast reconstruction. This method enhances safety and efficiency, potentially increasing access to autologous reconstruction for this population.

Keywords:
Autologous breast reconstructionBody mass index (BMI)DIEP flapMicrosurgeryObesityOverweight

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Surgical Innovation

Background:

  • High body mass index (BMI) presents challenges in autologous breast reconstruction using deep inferior epigastric perforator (DIEP) flaps.
  • Increased risks include wound healing complications, fat necrosis, and donor-site morbidity.
  • Intraoperative technical difficulties during flap harvest in high-BMI patients are underreported.

Purpose of the Study:

  • To describe a reproducible, single-operator technique for deep inferior epigastric perforator (DIEP) flap harvest in high BMI patients.
  • To address the intraoperative technical challenges associated with managing a heavy abdominal pannus.
  • To streamline flap harvest, reduce surgeon strain, and improve operative efficiency.

Main Methods:

  • A modified approach involving limited incision and dissection to harvest only necessary flap dimensions.
  • Sequential exposure down to fascia with a suspension suture for superior abdominal skin secures.
  • Focused identification of the superficial inferior epigastric vein (SIEV) via a longitudinal incision, avoiding wide pannus retraction.

Main Results:

  • The technique simplifies pannus management and optimizes exposure, enhancing safety and reproducibility.
  • Reduced dependence on experienced assistance and minimized operator strain.
  • Streamlined flap harvest, reduced surgeon energy expenditure, and shortened operative times observed in this patient subgroup.

Conclusions:

  • This modified DIEP flap harvest technique overcomes challenges in high-BMI patients.
  • The approach enhances safety, efficiency, and reproducibility of autologous breast reconstruction.
  • Wider access to safe, natural-tissue breast reconstruction for high-BMI patients may be facilitated.