Download PDF
Open Access
CC BY-NC 4.0 · Arch Plast Surg 2014; 41(01): 63-70
DOI: 10.5999/aps.2014.41.1.63
Original Article

The Impact of Perforator Number on Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Authors

  • Ritwik Grover

    Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

  • Jonas A Nelson

    Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

  • John P Fischer

    Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

  • Stephen J Kovach

    Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

  • Joseph M Serletti

    Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

  • Liza C Wu

    Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
Further Information
  Permissions and Reprints

BackgroundPerforator flaps minimize abdominal site morbidity during autologous breast reconstruction. The purpose of this study was to assess whether the number of perforators harvested influences the overall deep inferior epigastric perforator (DIEP) flap survival and flap-related complications.

MethodsA retrospective review was performed of all DIEP flaps performed at the Hospital of the University of Pennsylvania from 2006 to 2011. The outcomes assessed included flap loss and major complications. We compared flaps by the number of total perforators (1-4) and then carried out a subgroup analysis comparing flaps with one perforator to flaps with multiple perforators. Lastly, we conducted a post-hoc analysis based on body mass index (BMI) categorization.

ResultsThree hundred thirty-three patients underwent 395 DIEP flaps. No significant differences were noted in the flap loss rate or the overall complications across perforator groups. However, the subgroup analysis revealed significantly higher rates of fat necrosis in the case of one-perforator flaps than in the case of multiple-perforator flaps (10.2% vs. 3.1%, P=0.009). The post-hoc analysis revealed a significant increase in the flap loss rate with increasing BMI (<30=2.0%, 30-34.9=3.1%, 35-39.9=3.1%, >40=42.9%, P<0.001) in the DIEP flaps, but no increase in fat necrosis.

ConclusionsThis study demonstrates that the number of perforators does not impact the rate of flap survival. However, the rate of fat necrosis may be significantly higher in DIEP flaps based on a single perforator. Multiple perforators should be utilized if possible to decrease the risk of fat necrosis.

Keywords

Breast reconstruction - Outcome assessment (health care) - Microsurgery

The authors would like to express their sincere gratitude to Nancy Folsom BSN for assistance with and preparation for the IRB review.


This article was presented at the American Society for Reconstructive Microsurgery Annual Meeting 2013, January 14, 2013 in Naples, FL, USA.




Publication History

Received: 21 October 2013

Accepted: 03 December 2013

Article published online:
02 May 2022

© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA