PR22 *THE STACKED DIEP FLAP FOR BREAST RECONSTRUCTION: A RELIABLE OPTION FOR COMPLEX CASES WITH THE USE OF PREOPERATIVE IMAGING

Abstract

Background: Autologous reconstruction with the deep inferior epigastric artery (DIEA) perforator (DIEP) flap is increasingly utilized for breast reconstruction. However, situations arise in which the DIEP flap is not an appropriate option, including the presence of a midline abdominal scar or an inadequate volume of abdominal tissue. While other donor sites may be considered, the stacked DIEP flap, in which the perforators of both hemi‐abdominal walls are utilized in a single vascular pedicle, provides a safe technique to utilize the integument of both hemi‐abdominal walls.Methods: Five consecutive patients underwent a stacked DIEP flap for breast reconstruction. Preoperative imaging with computed tomographic angiography (CTA) of the abdominal wall was undertaken, with each DIEA, its branching pattern, and all musculocutaneous perforating branches mapped using three‐dimensional software reconstructions. The anatomical basis, operative technique and outcomes are discussed.Results: In all cases, CTA was able to demonstrate individual vascular anatomy, and guide planning for a stacked DIEP flap. Unique anatomy between individuals required a range of variations in flap anatomy, with the contralateral DIEA, SIEA, or perforators each used to perfuse the contralateral hemi‐abdominal wall. There was a 100% flap survival, with no donor site morbidity reported.Conclusion: The stacked DIEP flap is a safe and reliable technique for augmenting the perfusion of the abdominal wall in cases where the single pedicle DIEP flap is limited. The anatomical basis of the flap can be planned preoperatively with CTA, facilitating faster operating times and good outcomes.