A New CT Analysis of Abdominal Wall after DIEP Flap Harvesting.

Tito Brambullo,Barbara Ravara,Roberto Vezzaro,Franco Bassetto,Eva Kohlscheen,Stefano Masiero,Francesco Messana,Vincenzo Vindigni,Giulia Pranovi,Sandra Zampieri,Diego Faccio

doi:10.3390/diagnostics12030683

Abstract

The abdominal microsurgical flap based on the deep inferior epigastric artery perforator (DIEP) flap has become the most popular option worldwide for autologous breast reconstruction. Several authors have investigated the results of reconstructed breasts, but the literature lacks systematic reviews exploring the donor site of the abdominal wall. To fulfil our aims, a new diagnostic muscle imaging analysis was designed and implemented. This study focused on rectus abdominal muscle morphology and function in a single series of 12 consecutive patients analysed before and after breast reconstruction with a microsurgical DIEP flap. Patients were divided into two groups, namely, “ipsilateral reconstruction” and “contralateral reconstruction”, depending on the side of the flap harvest and breast reconstruction, then evaluated by computed tomography (CT) scans scheduled for tumor staging, and clinically examined by a physiatrist. Numerous alterations in muscle physiology were observed due to surgical dissection of perforator vessels, and rectus muscle distress without functional impairment was a common result. Postoperatively, patients undergoing “contralateral reconstruction” appeared to exhibit fewer rectus muscle alterations. Overall, only three patients were impacted by a long-term deterioration in their quality of life. On the basis of the newly developed and implemented diagnostic approach, we concluded that DIEP microsurgical breast reconstruction is a safe procedure without major complications at the donor site, even if long-term alterations of the rectus muscle are a common finding.

Highlights

We report the correlation between imaging and clinical changes to the abdominal wall in patients who have undergone autologous breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap
In our study, based on a comparison between preoperative and postoperative exmedial row perforators (M-DIEP) in order to reduce postoperative muscle wall impairment, despite a more tedious dissection compared to lateral row perforators amination with computed tomography, a number of dimensional changes (L-DIEP)
Computed tomography shows that the muscle wall is constantly developing postoperative sequelae after harvesting the DIEP flap, even if these are not directly correlated with a functional impairment demonstrated by the physiatrist

Summary

Introduction

Over the past 20 years, the deep inferior epigastric perforator (DIEP) flap has become the most popular option for autologous breast reconstruction due to its assumed low donor site morbidity and natural aesthetic results [1].It ideally represents the evolution of the transverse rectus abdominis myocutaneous flap (TRAM), with the significant advantage of sparing the rectus abdominis muscle with subsequent preservation of the abdominal wall integrity [2–4].According to the Mathes and Nahai classification, the rectus abdominis muscle receives a type 3 vascular supply, with two dominant pedicles, one at each end of the muscle [5].creativecommons.org/licenses/by/ 4.0/).The last three posterior lumbar arteries and the deep circumflex artery can provide small anastomoses with the epigastric arteries’ lateral branches, contributing to rectus abdominis vascular supply [6].In breast reconstruction with an ipsilateral DIEP flap, the internal mammary artery of the same side is the first choice for an anastomose with the deep inferior epigastric artery; only in selected cases do surgeons prefer the thoracodorsal vessels [7,8].This way, even the superior epigastric artery, which is the anatomic extension of the internal mammary, is interrupted. Over the past 20 years, the deep inferior epigastric perforator (DIEP) flap has become the most popular option for autologous breast reconstruction due to its assumed low donor site morbidity and natural aesthetic results [1]. It ideally represents the evolution of the transverse rectus abdominis myocutaneous flap (TRAM), with the significant advantage of sparing the rectus abdominis muscle with subsequent preservation of the abdominal wall integrity [2–4]. In breast reconstruction with an ipsilateral DIEP flap, the internal mammary artery of the same side is the first choice for an anastomose with the deep inferior epigastric artery; only in selected cases do surgeons prefer the thoracodorsal vessels [7,8].

Methods

Discussion

Conclusion