Retrorectus Polyglactin Mesh Reduces the Risk of Bulge in DIEP Flap Donor Sites: A Propensity Score-Matched Study...

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Surgical Complications

Background:

• Hernia and bulge are known complications following deep inferior epigastric perforator (DIEP) flap harvest.
• Assessing and mitigating these risks is crucial for patient outcomes in breast reconstruction.

Purpose of the Study:

• To evaluate the efficacy of retrorectus placement of absorbable polyglactin mesh in reducing hernia and bulge after DIEP flap harvest.
• To introduce a sliding scale estimator for individualized hernia risk assessment, with and without mesh use.

Main Methods:

• Retrospective, single-center cohort study of 330 patients undergoing DIEP flap breast reconstruction (March 2018 - September 2023).
• Comparison of donor-site outcomes (hernia, bulge) between patients with and without retrorectus polyglactin mesh.
• Propensity score matching, multivariable logistic regression, and nomogram development for hernia risk prediction.

Main Results:

• Polyglactin mesh placement was associated with significantly lower postoperative bulge (1.2% vs. 9.3%, p=0.017) after propensity score matching.
• Age, lateral perforator harvest, and medial perforator count predicted hernia; polyglactin mesh predicted reduced bulge.
• A logistic regression model (AUC = 0.97) was developed to estimate individualized hernia risk with and without mesh.

Conclusions:

• Retrorectus polyglactin mesh effectively reduces bulge after DIEP flap harvest.
• Hernia risk is influenced by patient age, prior surgery, and perforator dissection.
• A validated nomogram aids in personalized risk estimation and surgical decision-making for DIEP flap reconstruction.