Trickle Charging Flaps: Maintaining Deep Inferior Epigastric Perforator Flap Perfusion After Pedicle Division

Trickle charging is a process by which an external power supply is used to maintain charge in a battery. When applied to flaps, trickle charging allows temporary perfusion of the flap (battery) by using a perforator that is discontinuous from the main pedicle (external power supply), allowing main pedicle ligation. Two procedures that benefit from this technique are the conventional open bilateral deep inferior epigastric perforator (DIEP) flap and the robotic bilateral DIEP flap.

In the conventional open bilateral DIEP flap, trickle charging is used to improve perioperative efficiency. In the event that the recipient site is not ready for flap transfer (ie, mastectomy and/or chest vessel preparation are not completed), trickle charging enables the main pedicle to be harvested from the intraabdominal cavity. This facilitates early rectus fascia and partial abdominal closure. In a bilateral robotic DIEP flap, trickle charging allows the second hemi-abdominal flap to maintain perfusion after the main pedicles in the intra-abdominal cavity are robotically harvested. Both scenarios demonstrate the possibility of temporary perfusion of the flap, despite the main pedicle being ligated.

Sixteen total patients had hemi-abdominal flaps that were trickle charged (5 conventional, 11 robotic). All the flaps were tested for proper perfusion intraoperatively using multiple different modalities. None of the patients experienced total flap loss, partial flap loss, or fat necrosis.

The authors review the safety of trickle charging in consecutive robotic and open bilateral DIEP flap breast reconstructions. This technique can be easily replicated for various other flaps with the help of preoperative computed tomography or magnetic resonance angiography to identify main pedicle vessels and an alternative temporary perforator.