Limiting the fascia incision length in a DIEP flap: Repercussion on abdominal wall morbidity
| Autor: | Randy De Baerdemaeker, Lloyd Nanhekhan, Gerd Fabre, Marc Vandevoort, Paulien H. Hilven, Frans Bruyninckx, Quinten Peeters, Yamina Dupont |
|---|---|
| Přispěvatelé: | Surgical clinical sciences, Plastic Surgery |
| Rok vydání: | 2022 |
| Předmět: |
electromyography
medicine.medical_specialty Abdominal wall function Autologous flap Mammaplasty Rectus Abdominis Electromyography Abdominal wall Neurogenic changes Postoperative Complications DIEP flap medicine Humans Fascia Retrospective Studies medicine.diagnostic_test business.industry Abdominal Wall Donor morbidity Rectus muscle Limiting musculoskeletal system Epigastric Arteries eye diseases Surgery Breast Reconstruction medicine.anatomical_structure Morbidity business Breast reconstruction Perforator Flap |
| Zdroj: | Journal of Plastic, Reconstructive & Aesthetic Surgery. 75:1108-1116 |
| ISSN: | 1748-6815 |
| DOI: | 10.1016/j.bjps.2021.11.020 |
| Popis: | BACKGROUND: The evolution from free muscle-sparing transverse rectus abdominis myocutaneous flap to deep inferior epigastric perforator (DIEP) flap leads to less donor-site morbidity. However, rectus fascia is usually incised longitudinally from perforator(s) to iliac vessels, often exceeding 15 cm when including longitudinal muscle spreading. By using a limited fascia incisional (LFI-) technique, we try to diminish abdominal wall functional decrease. METHODS: Twenty-seven patients who underwent unilateral breast reconstructions using free DIEP-flap with limited fascia incision between December 2014 and October 2017 were included in the study. Each patient received a periumbilical electromyogram (EMG) preoperatively, at 6 and 14 weeks postoperatively. They were compared with 27 patients having unilateral breast reconstructions using classic free DIEP-flap, performed at the same department between November 2009 and May 2011. RESULTS: In our LFI-technique, one vertical (4 cm) incision is made where the pedicle exits the muscle. A second, oblique (3 cm) incision is made more distally where the pedicle runs into the iliac vessels. After release, the pedicle is tunneled through the incisions, leaving all fascia, and therefore muscle, intact. In the LFI-group small neurogenic changes were noticed in only 26% and 11% of the patients at, respectively, 6 and 14 weeks postoperatively. By contrast, in the control group, postoperative neurogenic deviations remained in 37% of the patients at 14 weeks postoperatively; significant different compared to the LFI-group. CONCLUSION: This study shows the importance of preserving anterior rectus fascia. Nerve supply and abdominal rectus muscle function are less endangered using small segmental fascia incisions. We believe that our technique diminishes donor-site morbidity significantly and improves the postoperative recovery. |
| Databáze: | OpenAIRE |
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