Does the Difference in Vascular Anatomy in the Multiple Perforator DIEP Flap Affect the Flap Dissection Time?

Area of Science:

• Microsurgery
• Plastic Surgery
• Breast Reconstruction

Background:

• Deep inferior epigastric perforator (DIEP) flaps offer superior perfusion for breast reconstruction.
• Perforator selection involves factors like number, running layer, pedicle length, and branching pattern.
• Optimizing DIEP flap dissection time is crucial for surgical efficiency.

Purpose of the Study:

• To investigate the relationship between anatomical characteristics of perforators and flap dissection time in DIEP flap breast reconstruction.
• To identify predictors of prolonged dissection time in multiple perforator DIEP flaps.
• To inform surgical decision-making for efficient perforator selection.

Main Methods:

• A cohort study of 134 patients undergoing unilateral breast reconstruction with multiple perforator DIEP flaps.
• Patients were categorized into short-time and long-time flap dissection groups.
• Preoperative and intraoperative imaging analyzed perforator characteristics, including intramuscular course rate.

Main Results:

• Lower intramuscular course rates were associated with shorter dissection times (43.6% vs 50.3%, P=0.006).
• Multivariate analysis identified intramuscular course rate (P<0.001) and horizontal flap width (P=0.044) as significant predictors of dissection time.
• Factors like flap weight and total operative time also differed between groups.

Conclusions:

• Perforators with a higher intramuscular course rate are linked to increased flap dissection time.
• The perforator running layer is a critical consideration for pedicle selection to optimize dissection efficiency.
• Understanding these anatomical factors can improve surgical planning and reduce operative time in DIEP flap breast reconstruction.