Versatility of the vertical designed deep inferior epigastric perforator flap

Abstract

The deep inferior epigastric perforator (DIEP) flap is one of the most commonly used perforator flaps. However, when horizontally oriented, it has certain pitfalls such as sacrifice of the contralateral donor site, the need to discard soft tissue that will not be adequately perfused, and long operating times. To overcome these handicaps, the flap in a vertical orientation was designed and demonstrated the versatility of this technique in a number of different anatomical tissue restorations in this study. The vertical DIEP flaps were used in 8 patients (7 males and 1 female) in 3 years. Defects were located in the lower limb (4 cases), face (3 cases), and hip (1 cases). All flaps were transferred as free, except one in the hip that was pedicled. Flap sizes varied from 7 x 5 cm to 13 x 9 cm. All donor defects were closed primarily. The mean follow-up time was 13.6 months. All flaps survived totally, but one which had partial necrosis. A hematoma developed postoperatively in the donor site of the pedicled DIEP flap. Cosmetic outcomes were satisfactory in all patients. All donor site scars were acceptable with minimal contour irregularities. The vertical DIEP flap offers diverse opportunities in various soft tissue reconstructions and is candidate to be an important choice of free flap repertoire. The method can be proposed particularly for restoration of moderate sized defects rather than that of large defects as in postmastectomy breast reconstruction.