Safety and Efficacy of Endoluminal Vasodilators on the Prevention of Vasospasm in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Prospective Controlled Study

Abstract

Background The spasm of the internal mammary artery (IMA) and inferior epigastric pedicle (IEP) is critical in deep inferior epigastric perforator (DIEP) flap breast reconstruction. The aim of this study was to assess the safety and the efficacy of endoluminal vasodilators on the prevention of vasospasm in DIEP flap breast reconstruction. Methods Fifty-eight patients were included in a controlled study. Of the 58 patients, 29 patients were prospectively included and received a combination of 1 mg of isosorbide dinitrate and 0.25 mg of nicardipine injected into the IMA and IEP (intervention group) and 29 patients were retrospectively included and received no antispasmodic agents (control group). The efficacy outcome was the flap viability. The safety outcome was the mean central blood pressure. Results The rate of flap necrosis was lower in the intervention group than in the control group (0 vs. 10.34%; p = 0.2). The mean blood pressure was not significantly different between the two groups after injection ( p = 0.403). Conclusion Injecting nicardipine and isosorbide dinitrate into the IMA and IEP could be used as a new strategy to prevent vasospasm in DIEP flap breast reconstruction.