Beyond Body Mass Index: Using Abdominal Wall Thickness to Guide Patient Selection for Deep Inferior Epigastric...

Area of Science:

• Plastic Surgery
• Surgical Oncology
• Biomedical Engineering

Background:

• Current Body Mass Index (BMI) guidelines for autologous breast reconstruction may not accurately assess patient risk.
• Obesity and associated complications are significant concerns in DIEP flap procedures.
• Novel methods are needed to better evaluate patient suitability for DIEP flap reconstruction.

Purpose of the Study:

• To evaluate the relationship between abdominal wall thickness (AWT) and post-operative complication rates in DIEP flap reconstruction.
• To determine if AWT is a more accurate predictor of complications than BMI.
• To identify a potential AWT threshold for predicting complications.

Main Methods:

• Retrospective review of 793 patients (1310 flaps) undergoing DIEP flap reconstruction.
• Measurement of subcutaneous AWT from pre-operative CT angiograms at standardized landmarks.
• Stratification of patients by BMI and AWT categories for comparative analysis.

Main Results:

• BMI and AWT were both strong predictors of post-operative complications (p < 0.001).
• Increased AWT correlated with higher rates of wound dehiscence, infection, and fat necrosis.
• An AWT threshold of 26.3 mm was identified for predicting overall complications.
• AWT and BMI models showed comparable predictive accuracy, with AWT offering unique insights in cases of BMI/AWT mismatch.

Conclusions:

• Abdominal wall thickness (AWT) is a valuable adjunct to BMI in assessing DIEP flap eligibility.
• AWT measurement can help identify patients at higher risk of complications, especially when BMI is discordant.
• This accessible measurement method can refine patient selection for autologous breast reconstruction.