Abstract
Despite the popularity of breast reconstruction with abdominal flap, the integrity of the abdominal wall gets compromised after the operation. To decrease donor site morbidity, researchers have developed various inlay or onlay graft materials. However, the indications of use are unclear and dependent on the subjective decision of the surgeons. In this study, we have investigated donor site morbidities in breast reconstruction with free abdominal flap surgery in which graft materials were not used. We reviewed 461 consecutive cases for the preoperative characteristics of patients, intraoperative details, and postoperative donor site complications from May 2013 to March 2019. While 386 patients underwent deep inferior epigastric perforators (83.7%), muscle sparing type 2 transverse rectus abdominis musculocutaneous flaps were performed in 75 patients (16.3%). Bilateral dissection of the pedicle was performed in 162 patients, compared to unilateral dissection in 299 patients. The mean follow-up duration was 22.7 months. The overall complication rate in the donor site was 7.2%. The flap height was significantly associated with the overall complication. While majority of them were delayed wound healing (n = 28, 6.1%), there were four cases of hematoma (0.9%). There were two cases of bulging (0.4%), which occurred in patients receiving bipedicle dissection; however, there was no case of hernia. Conclusions. Breast reconstruction with an abdominal free flap can be safely performed without fascia reinforcement graft even with bilateral dissection of the pedicle. With complete preservation of fascia and zigzag fascial incision, a low incidence of abdominal bulging can be obtained even with bilateral harvesting of the flap.
Highlights
Despite the evolution of the surgical technique, which decreases the damage in muscle and fascia, reconstruction with abdominal free flap may result in abdominal bulging and hernia
Notwithstanding the variations, the rates of abdominal flap complications range from 4% to 20% and 0.7% to 5% for free transverse rectus abdominis musculocutaneous (TRAM) flap and deep inferior epigastric perforators (DIEP) flap, respectively [1,2,3]
This study indicates that according to the undermentioned principle of the fascial sparing technique, donor site morbidity can be minimized even without reinforcement graft during bilateral dissection
Summary
Despite the evolution of the surgical technique, which decreases the damage in muscle and fascia, reconstruction with abdominal free flap may result in abdominal bulging and hernia. Researchers have developed various inlay graft materials, such as polypropylene mesh or a bioprosthetic material (acellular dermal matrix), which decrease the donor site morbidity and strengthen the abdominal fascia [4, 5]. The use of graft reduces the tension at the fascial repair site, facilitates midline position of umbilicus, and avoids an asymmetrical lower abdominal contour [4]. They impose an extra financial burden on the patients and can lead to infection or delayed wound healing. The indication of use is unclear and dependent on the subjective decision of the surgeons
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