深部下腹壁穿通枝（DIEP）皮弁術における腹部合併症低減のためのレトロレクタスメッシュ使用

Deep inferior epigastric perforator (DIEP) flaps provide a durable, autologous breast reconstruction option, but can lead to post-operative abdominal bulges and hernias. There is no current standardization in practice for fascial closure or mesh placement. Bioprosthetic poly-4-hydroxybutyrate (P4HB) mesh allows for temporary abdominal support without the long-term risks of permanent mesh.

A retrospective chart review was conducted of a single surgeon's patients who underwent DIEP flaps from 2020-2024. During the study period the primary surgeon began using retrorectus bioprosthetic mesh prior to fascial closure. Abdominal bulge was a clinical diagnosis made by the attending surgeon, and any patient with concern for a hernia received post-operative imaging. Analysis was conducted with R and included Fisher's exact test, Shapiro-Wilk's test, Mann-Whitney U test, and t-tests.

This study included 118 patients, 59 with mesh and 59 without mesh, with similar baseline patient demographics. There was a 5.1% bulge rate in the group with mesh compared to 18.6% in those without mesh (p=0.04). There was no significant difference in hernia rates, with the base rate remaining low for these patients (p=1.0). There were no statistically significant differences in the rates of seroma or infection between the groups (p=1.0).

There was a three-fold decrease in the rate of abdominal bulge after DIEP flap surgery with retrorectus P4HB mesh. True hernia risk remains low in these patients. Retrorectus mesh placement is a straightforward and quick addition to DIEP flap harvest and may help to reduce the abdominal morbidity of this surgery.