Management of subcostal scars during DIEP-flap raising

Abstract

The lower abdomen continues to be the favourite donor site for free tissue transplantation in autologous breast reconstruction. The deep inferior epigastric artery (DIEP)-flap has revolutionised microsurgical reconstruction of the breast after mastectomy. However, previous abdominal operations with resulting subcostal scars limit the use of this flap due to possible severe complications such as fat necrosis or wound break down at the donor site. We present a method to avoid such problems that could equally be applied in simple abdominoplasties under similar conditions. After harvest of the DIEP-flap the cephalad wound edge has to be undermined for direct wound closure. Instead of ligating encountered perforating vessels, one of these perforators is prepared and left intact to provide perfusion for the distal part of the cranial abdominal flap below the scar. With this technique, the DIEP-flap can be harvested safely even in the presence of abdominal scars and, thus, is not contraindicated under these circumstances any longer.