Indications of the DIEP flap in extra-mammary complex wounds: From head to extremity reconstruction

Berkane Y., Giorgino R., Ng Z.Y., Dukan R., Lellouch A.G.

For major upper limb defects, a wide range of established pedicled and free flap options can be used. These include the latissimus dorsi/thoracodorsal artery perforator, lateral arm, posterior interosseous artery, rectus abdominis, gracilis, and anterolateral thigh flaps. Technical proficiency is essential, and favorable success rates in terms of functional and esthetic outcomes can be achieved. Herein, alternative flap options (both pedicled and free) are introduced and discussed through a few illustrative case examples.

Guinier C., Clermont-Tonnerre E.D., Tay J.Q., Ng Z.Y., Cetrulo Jr C.L., Lellouch A.G.

Lee S.Y., Seok M.C., Park B.Y.

Background One-stage reconstruction with ‘thin perforator flaps’ has been attempted to salvage limbs and restore function. The deep inferior epigastric perforator (DIEP) flap is commonly utilized flap in breast reconstruction (BR). The purpose of this study is to present the versatility of DIEP flaps for the reconstruction of large defects of the extremities. Methods Patients with large tissue defects on extremities who were treated with thin DIEP flaps from January 2016 to January 2018 were included. They were minimally followed up for 36 months. We analyzed the etiology and location of the soft tissue defect, flap design, anastomosis type, outcome, and complications. We also considered the technical differences in the DIEP flap between breast and extremity reconstruction. Results Overall, six free DIEP flaps were included in the study. The flap size ranged from 15 × 12 to 30 × 16 cm2. All flaps were transversely designed similar to a traditional BR design. Three flaps were elevated with two perforators. Primary closure of the donor site was possible in all cases. Five flaps survived with no complications. However, partial necrosis occurred in one flap. Conclusion A DIEP flap is not the first choice for soft tissue defects, but it should be considered for one-stage reconstruction of large defects when the circulation zone of the DIEP flap is considered. In addition, this flap has many advantages over other flaps such as provision of the largest skin paddle, low donor site morbidity with a concealed scar, versatile supercharging technique, and a long pedicle.

Nikkhah D., Bhat W., Williams A., Bourke G.

Allen R.J., Treece P.

The ideal material for reconstruction of a breast is fat and skin. Most current methods of autogenous reconstruction use myocutaneous flaps. We investigated the feasibility of transfer of skin and fat from the lower abdomen without muscle sacrifice. The flap is based on one, two, or three perforators of the deep inferior epigastric vessels. The study will demonstrate both experimentally and clinically this original technique for breast reconstruction. Fifteen breasts have been successfully reconstructed with this technique. This technique has all of the advantages of the free transverse rectus abdominis myocutaneous flap with decreased possibility of ventral hernia or muscle weakness.

Van Landuyt K., Blondeel P., Hamdi M., Tonnard P., Verpaele A., Monstrey S.

The deep inferior epigastric perforator (DIEP) flap gained widespread popularity as a free flap in breast reconstruction. It is also a versatile and reliable supply of a large amount of skin and soft-tissue, which can be used in other types of reconstruction. We present 25 consecutive cases (28 DIEP flaps) performed in our service during the past 5 years for different indications in lower extremity aesthetic and functional reconstruction, both as pedicled or free flaps. The amount of tissue provided, its reliable vascular supply and long and adequately sized pedicles, together with its limited donor-site morbidity make it a useful alternative free flap.

Koshima I., Soeda S.

The rectus abdominis musculocutaneous flap has many advantages, but its disadvantages are also well-known. These are the possibility of abdominal herniation and, in certain situations, its bulk. To overcome these problems, an inferior epigastric artery skin flap without rectus abdominis muscle, pedicled on the muscle perforators and the proximal inferior deep epigastric artery, have been used in two patients. A large flap without muscle can survive on a single muscle perforator.