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Semin Plast Surg 2006; 20(2): 095-102
DOI: 10.1055/s-2006-941716
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

The Deep Inferior Epigastric Artery Perforator Flap (DIEAP) in Breast Reconstruction

Moustapha Hamdi1 , Alanna Rebecca1
  • 1Department of Plastic Surgery, Gent University Hospital, Gent, Belgium
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Publication History

Publication Date:
29 May 2006 (online)

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ABSTRACT

As the diagnosis of breast cancer increases, so does the amount of information available to the patient regarding treatment. Patients have become more informed regarding treatment and reconstructive options in recent years. The plastic surgery community has attempted to provide reconstructive options that give the best result with the least donor-site morbidity. By using these criteria, the deep inferior epigastric artery perforator flap (DIEAP) flap has been developed based on previous experience with the free and pedicled transverse rectus abdominis myocutaneous flap reconstruction. The DIEAP flap provides autologous tissue for breast reconstruction, which is similar in makeup to the patient's own breast, while minimizing donor-site morbidity. Over the past decade, the DIEAP flap has been a reliable and reproducible method for autologous breast reconstruction.

KEYWORDS

DIEP - DIEAP - perforator flap - autologous breast reconstruction

REFERENCES

  • 1 Holmstrom H. The free abdominoplasty flap and its use in breast reconstruction. An experimental study and clinical case report.  Scand J Plast Reconstr Surg. 1979;  13 423-427
    CrossrefPubMedGoogle Scholar
  • 2 Robbins T H. Rectus abdominis myocutaneous flap for breast reconstruction.  Aust N Z J Surg. 1979;  49 527-530
    PubMedGoogle Scholar
  • 3 Hartrampf C R, Scheflan M, Black P W. Breast reconstruction with a transverse abdominal island flap.  Plast Reconstr Surg. 1982;  69 216-225
    CrossrefPubMedGoogle Scholar
  • 4 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle.  Br J Plast Surg. 1989;  42 645-648
    CrossrefPubMedGoogle Scholar
  • 5 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg. 1994;  32 32-38
    Google Scholar
  • 6 Hamdi M, Weiler-Mithoff E, Webster M H. Deep inferior epigastric perforator flap in breast reconstruction: experience with the first 50 flaps.  Plast Reconstr Surg. 1999;  103 86-95
    CrossrefPubMedGoogle Scholar
  • 7 Blondeel P N. One hundred free DIEP flap breast reconstructions: a personal experience.  Br J Plast Surg. 1999;  52 104-111
    CrossrefPubMedGoogle Scholar
  • 8 Hamdi M, Blondeel P, Van Landuyt K, Tondu T, Monstrey S. Bilateral autogenous breast reconstruction using perforator free flaps: a single center's experience.  Plast Reconstr Surg. 2004;  114 83-89
    CrossrefPubMedGoogle Scholar
  • 9 Milloy F J, Anson B J, McAfee D K et al.. The rectus abdominis muscle and the epigastric arteries.  Surg Gynecol Obstet. 1960;  110 293-302
    PubMedGoogle Scholar
  • 10 Kikuchi N, Murakami G, Kashiwa H et al.. Morphometrical study of the arterial perforators of the deep inferior epigastric perforator flap.  Surg Radiol Anat. 2001;  23 375-381
    PubMedGoogle Scholar
  • 11 Heitmann C, Felmerer G, Durmus C et al.. Anatomical features of perforator blood vessels in the deep inferior epigastric perforator flap.  Br J Plast Surg. 2000;  53 205-208
    CrossrefPubMedGoogle Scholar
  • 12 El-Mrakby Hamdy H, Milner R H. The vascular anatomy of the lower anterior abdominal wall: a microdissection study on the deep inferior epigastric vessels and the perforator branches.  Plast Reconstr Surg. 2002;  109 539-543
    CrossrefPubMedGoogle Scholar
  • 13 El-Mrakby Hamdy H, Milner R H. The suprafascial course of the direct paraumbilical perforator vessels.  Plast Reconstr Surg. 2002;  109 1766-1768
    PubMedGoogle Scholar
  • 14 Holm C, Mayr M, Hofter E, Ninkovic M. Perfusion zones of the DIEP flap revisited: a clinical study.  Plast Reconstr Surg. 2006;  117 37-43
    CrossrefPubMedGoogle Scholar
  • 15 Blondeel P N, Beyens G, Verhaeghe R et al.. Doppler flowmetry in the planning of perforator flaps.  Br J Plast Surg. 1998;  51 202-209
    Google Scholar
  • 16 Masia J, Clavero J A, Larrañaga J R et al.. Multidetector-row computed tomography in the planning of abdominal perforator flaps.  J Plast Reconstr Aesthetic Surg. 2006;  , In press
    PubMedGoogle Scholar
  • 17 Blondeel P N, Arnstein M, Verstraete K et al.. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps.  Plast Reconstr Surg. 2000;  106 1295-1299
    CrossrefPubMedGoogle Scholar
  • 18 Wechselberger G, Scholler T, Bauer T et al.. Venous superdrainage in the deep inferior epigastric perforator flap breast reconstruction.  Plast Reconstr Surg. 2001;  108 162-166
    CrossrefPubMedGoogle Scholar
  • 19 Hamdi M, Van Landuyt K, Blondeel P, Monstrey S. Bipedicled abdominal free flaps for unilateral breast reconstruction. Presented at the 17th Annual Meeting of the European Association of Plastic Surgeons (EURAPS) May 25-27 2006 Ankara, Turkey;
    Google Scholar
  • 20 Chang D W, Wang B, Robb G L et al.. Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction.  Plast Reconstr Surg. 2000;  105 1640-1648
    CrossrefPubMedGoogle Scholar
  • 21 Hamdi M, Blondeel P, Van Landuyt K, Monstrey S. Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: the role of the internal mammary perforators.  Br J Plast Surg. 2004;  57 258-265
    CrossrefPubMedGoogle Scholar
  • 22 Munhoz A M, Sturtz G, Montag E et al.. Clinical outcome of abdominal wall after DIEP flap harvesting and immediate application of abdominoplasty techniques.  Plast Reconstr Surg. 2005;  116 1881-1893
    CrossrefPubMedGoogle Scholar
  • 23 Rossillon D, Vanwyck R, Bayet B, Calteux N, De Coninck A. The action of piracetam in ischemic flaps.  Br J Plast Surg. 1987;  40 459-466
    CrossrefPubMedGoogle Scholar
  • 24 Gill P, Hunt J P, Guerra A et al.. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction.  Plast Reconstr Surg. 2004;  113 1153-1160
    CrossrefPubMedGoogle Scholar
  • 25 Chang D W, Reece G P, Wang B et al.. Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction.  Plast Reconstr Surg. 2000;  105 2374-2380
    CrossrefPubMedGoogle Scholar
  • 26 Nahabedian M Y, Momen B, Galdino G et al.. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome.  Plast Reconstr Surg. 2002;  110 466-475
    CrossrefPubMedGoogle Scholar
  • 27 Heller L, Feledy J A, Chang D W. Strategies and options for free TRAM flap breast reconstruction in patients with midline abdominal scars.  Plast Reconstr Surg. 2005;  116 753-759
    CrossrefPubMedGoogle Scholar
  • 28 Blondeel N, Vanderstraeten G G, Monstrey S J et al.. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction.  Br J Plast Surg. 1997;  50 322-330
    Google Scholar
  • 29 Nahabedian M Y, Tsangaris T, Momen B. Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference?.  Plast Reconstr Surg. 2005;  115 436-444
    CrossrefPubMedGoogle Scholar

Moustapha HamdiM.D. 

Professor of Plastic Surgery, University Hospital Gent, Department of Plastic Surgery

De Pintelaan 185, 9000 Gent, Belgium

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