O150: Perforator Related Risk Factors for Perfusion Related Complications in DIEP Flap Breast Reconstruction

Abstract

Abstract Introduction Despite advancements in DIEP flap breast reconstruction, perfusion related complications (PRCs) remain a concern. Such complications can negatively affect the aesthetic outcome, necessitate revisional surgery and delay adjuvant chemotherapy and radiotherapy. The aim of our study was to investigate the impact of perforator diameter, perforator row, and shortest distance between perforator and flap edge on the development of PRCs. Methods Prospectively kept data was retrospectively analysed for consecutive patients who underwent unilateral DIEP flap breast reconstruction from January 2008 to January 2023. Significant risk factors (p < 0.05) in univariate analysis were included in multivariate analysis to identify risk factors for PRCs. Additionally, receiver operating characteristic (ROC) curve analysis was conducted to identify the critical shortest distance between perforator and flap edge distinguishing PRCs. Results 292 cases of unilateral DIEP flap breast reconstruction were identified, with a mean patient age of 52.6 years. PRCs occurred in 65 (22.3%) cases. Multivariate logistic regression identified shortest distance between perforator and flap edge to have a significant impact on the incidence of PRCs. ROC curve analysis found the critical shortest distance between perforator and flap edge distinguishing PRCs to be 42.5mm. Conclusions Our study shows that the shortest distance between perforator and flap edge is the strongest predictor for PRCs in DIEP flap breast reconstruction. As several perforator related factors come into consideration when designing and performing DIEP flap breast reconstruction, our findings can guide surgeons in this decision making.