Abstract
Background Deep inferior epigastric perforator (DIEP) flaps are routinely elevated on a single
dominant perforator from the deep epigastric vascular system. However, the single
perforator may not always perfuse an entire flap adequately, particularly suprascarpal
tissue. We often perform “dual-plane” single perforator DIEP flaps by rerouting the
superficial (SIEA/V) system directly into a branch of the deep (DIEA/V) vascular system
pedicle, thus allowing both systems to contribute and enhance flap perfusion.
Methods A prospectively collected database of patients undergoing microvascular breast reconstruction
was reviewed for patients undergoing “dual-plane” DIEP flaps. These were matched to
a similar cohort of patients undergoing “traditional” single perforator DIEP free
flaps over the same time period. Treatment demographics and flap-specific morbidity
outcomes were assessed, including performance in the setting of radiation.
Results Over 2 years, 23 “dual-plane” DIEP flaps were performed (15 patients), compared with
35 single-perforator “traditional” DIEP flaps (23 patients). Rates of delayed healing
were similar between both cohorts (2.9 vs. 4.3%, p = 0.28). Rates of palpable fat necrosis were significantly lower in “dual-plane”
DIEP flaps compared with “traditional” flaps (0 vs. 14.3%, p = 0.03). Rates of clinically palpable fat necrosis following radiation were significantly
lower in the “dual-plane” flaps (4.3 vs. 40%, p = 0.02).
Conclusion The “dual-plane” DIEP flap is one we routinely consider in our algorithm, as it allows
for full preservation of functional abdominal musculature, and offers enhanced flap
perfusion by incorporating both the deep and superficial (dominant) vascular systems.
This results in lower fat necrosis rates, particularly in the setting of post-reconstruction
radiation.
Keywords
breast reconstruction - microsurgery - supercharging
