Perforator Flap Research Articles

Clinical Outcomes Following Profunda Artery Perforator Flap Breast Reconstruction: A Systematic Review and Meta-Analysis.

There is a lack of reliable evidence on the surgical outcomes of profunda artery perforator (PAP) flap breast reconstruction. We conducted a meta-analysis to evaluate its safety and compare it with deep inferior epigastric perforator (DIEP) flap, aiming to offer more information on whether the PAP flap was an ideal alternative for autologous breast reconstruction. PubMed, EMBASE, Web of Science and Cochrane Library were searched to retrieve relevant articles. The postoperative complication rates following PAP reconstruction were pooled. Mean differences of patients' age, BMI, mastectomy weight and flap weight between PAP and DIEP group were calculated, and relative risk was estimated to compare their incidence of complications. Twenty-four articles reporting 1612 PAP flap breast reconstructions were included. The surgical success rate was 99.6%; the incidence of total and partial flap loss was 0.4% and 0.0%; the incidence of infection, hematoma, seroma, fat necrosis and wound dehiscence in recipient sites was 0.3%, 1.4%, 1.0%, 3.3% and 0.3%, respectively; the incidence of infection, hematoma, seroma, wound dehiscence and sensory disturbance in donor sites was 2.0%, 0.9%, 3.5%, 9.2% and 0.6%, respectively. Compared to the DIEP group, the average age, BMI, mastectomy weight and final flap weight were significantly lower in the PAP group. No significant difference was observed in terms of flap failure, breast fat necrosis and donor site wound dehiscence. This systematic review demonstrates similar levels of postoperative morbidities for the PAP and DIEP flaps with some subtle differences and verifies the PAP flap as a second-line treatment for patients when the DIEP is unavailable or undesirable. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Use of the superficial circumflex iliac artery perforator flap for urethra and/or shaft reconstruction in gender diverse persons: 10-year single center experience.

Although the free radial forearm flap (FRFF) is the gold standard for phalloplasty, the conspicuous donor-site scar, need for microsurgery and the tendency for the phallus to deflate over time makes both patients and surgeons look for alternatives. We describe our long-term experience with the pedicled superficial circumflex iliac artery (SCIP) flap for urethral and/or penile shaft reconstruction. This flap can be applied for similar indications as FRFF-phalloplasty, but with primary closure of the donor site(s) and without microsurgery. We retrospectively reviewed surgical outcomes of all patients who underwent urethra and/or shaft reconstruction using SCIP-flaps as part of phalloplasty for gender-affirming surgery in our center between 2012 and 2022. Over a 10-year period, 55 SCIP-flaps were performed as part of phalloplasty. This included 47 unilateral SCIP-flaps, of which 10 were used for shaft reconstructions and 37 for urethra reconstructions. Primary closure was achieved in 100% of patients. No failures were observed for shaft reconstructions.For urethra reconstructions, 8 SCIP-urethras (14%) failed completely, and 3 SCIP-flaps were converted to free flaps. In total, 82% of patients with a SCIP-urethra reconstruction were able to stand while voiding.Eight bilateral SCIP-flaps were performed for one-stage shaft and urethra creation, of which 3 patients (38%) experienced urethral fistulas and/or strictures. This study shows that the SCIP-flap is a technically feasible and safe pedicled alternative for urethral and penile shaft reconstruction in gender diverse individuals, with similar urethral complication rates compared to FRFF and ALT-phalloplasty, however, with potentially lower shaft sensation.

Superficial circumflex iliac perforator flaps for maxilla defects with intraoral anastomosis or pedicle elongation techniques

BackgroundTo evaluate the feasibility and safety of the superficial circumflex iliac perforator flap (SCIP) for maxillary reconstruction with intraoral anastomosis, pedicle elongation, and super-microsurgery techniques to overcome its anatomical shortcomings due to the attractive merits of the flap.MethodsPatients who underwent reconstruction of maxillary defects with SCIPs from July 2020 to December 2022 were included. Intraoral anastomosis, pedicle elongation, and super-microsurgery were performed during surgery with or without a neck incision. The sizes, pedicle lengths, inner calibres of vessels, complications and flap survival statuses were recorded.ResultsA total of 12 patients were included, with 3 males and 9 females, and the median age was 45 years, ranging from 14 to 74 years. There were 5 class IIa and 7 class IIb defects, 6 cases underwent maxillary defect reconstruction via SCIPs with intraoral anastomosis, and the other 6 cases with distally design and/or de-epidermis pedicle elongation. Super-microsurgery interventions were needed in 5 patients. The size ranged from 3 cm×4 cm to 6 cm×8 cm. The pedicle length ranged from 4 cm to 12 cm, with a median of 6 cm. The inner caliber of the arteries ranged from 0.7 mm to 2 mm, with a median of 1 mm, and the veins ranged from 1.5 mm to 4 mm, with a median of 2.5 mm. All the flaps survived, and no donor site complications occurred.ConclusionSuperficial circumflex iliac perforator flaps can be regarded as feasible and safe choices for maxillary defects with the support of intraoral anastomosis, pedicle elongation and super-microsurgery.

Preventing Bird’s Beak Deformity: A narrative review of Innovations in Oncoplastic Surgery

Background: In the field of breast surgery, breast conserving surgery (BCS) is widely valued for its ability to preserve the breast while also achieving cosmetically acceptable outcomes and an overall survival rate comparable to that of total mastectomy. However, BCS has not always managed to achieved satisfactory cosmetic results. Among its challenges is the “bird’s beak” deformity, which is characterized by skin retraction and a downward deviation of the nipple areolar complex due to tissue excision from the lower pole of the breast. Methods: Various forms of oncoplastic surgery (OPS) have been developed to prevent bird’s beak deformity. These include volume displacement operations (such as superior pedicle mammoplasty, rotation technique and downward-mobilization procedure), as well as volume replacement techniques, including the latissimus dorsi mini-flap, thoracodorsal artery perforator flap, lateral intercostal artery perforator flap, anterior intercostal artery perforator flap, inframammary adipofascial flap and lipofilling. Conclusion: Choosing the most suitable approach for OPS requires careful consideration of various factors, notably the defect’s size and location, the size of the breast, and the thickness of subcutaneous fatty tissue. Further studies are required to firmly position these forms of OPS techniques in an evidence-based framework.

Lateral Calcaneal Artery Perforator/Propeller Flap in the Reconstruction of Posterior Heel Soft Tissue Defects

Abstract Introduction Posterior heel soft tissue defects with/without tendoachilles injury are difficult to reconstruct because of bony prominence, limited expendable local soft tissues, and significant donor site morbidity. In this study, we evaluate the lateral calcaneal artery (LCA) perforator/propeller flap for posterior heel soft tissue defect reconstruction. Materials and Methods A preliminary cadaveric study was done on 22 specimens to study the course of the LCA and its perforators. The knowledge gleaned from the cadaveric study was applied in our clinical study. The clinical study was conducted from January 2018 to May 2023 in 13 patients (10 males and 3 females) with posterior heel defects. The primary movement of the perforator flaps were either V-Y advancement (n = 10) or propeller (n = 3). Results All the flaps settled well except for superficial epidermolysis in one patient (7.69%) which healed conservatively. The average follow-up period was 14.53 months. Postoperatively, all patients had normal gait and normal range of movements. The LCA with the maximum number of perforators in the retrofibular/retromalleolar segment and the islanded flaps based on these perforators provided the excellent coverage for tendoachilles insertion defects and posterior heel defects facilitating excellent shoeability in all cases. Conclusion The study concludes that the LCA perforator/propeller flap may be a reliable cover for the posterior heel defects with good color, texture, thickness, and contour match rendering a shoeable stable foot.

Evolution and Adaptations of Robotic DIEP Flap Surgery: A Systematic Review.

The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery. A systematic literature search was conducted after PRISMA 2020 guidelines across databases including PubMed, Embase, Google Scholar, and Web of Science from 2000 to 2023. Articles exploring robotic DIEP flap harvest for breast reconstruction were assessed to compare operative techniques, clinical outcomes, and complications. The risk of bias was evaluated using ROBINS-I and the Newcastle-Ottawa scale. Fourteen studies involving 108 patients were included. Three studies used a totally extraperitoneal (TEP) technique, whereas 11 studies used a transabdominal preperitoneal (TAPP) approach. Preoperative planning utilized computed tomography angiography and magnetic resonance angiography imaging. The mean robotic operative time was 64 minutes, with total operative times averaging 574 minutes for TAPP and 497 minutes for TEP. The mean length of stay was 5 days, and the mean fascial incision length was 3cm. Overall complication rate was 14.9%, with no significant difference compared with conventional DIEP flap procedures. Robotic DIEP flap harvest is a promising technique that may reduce postoperative pain and limiting abdominal donor site morbidity. Potential limitations include longer operative times, variable hospital stays, and increased costs.

Breast reconstruction using the superficial circumflex iliac artery superficial branch perforator (SCISP) flap.

The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction. One downside is its risk of postsurgical herniation and bulging due to the opening of the rectus fascia and intramuscular dissection of the rectus abdominis muscle. Additionally this part of the surgery is very time consuming. While the superficial inferior epigastric artery perforator (SIEA) flap has been thoroughly described for total autologous breast reconstruction, the use of the superficial circumflex iliac artery perforator flap in this field is limited. This series introduces the use of an extended superficial circumflex iliac artery (SCIA) perforator flap nourished solely by perforators of the superficial branch of the SCIA- artery for total autologous breast reconstruction.Superficial preparation over the abdominal wall was performed without incising the rectus fascia, dissecting the superficial branch of the SCIA and its accompanying veins and the superficial inferior epigastric vein for additional venous drainage.Four patients underwent successful autologous breast reconstruction with this extended SCIP (superficial circumflex iliac artery perforator)-flap-variation. The term superficial circumflex iliac artery superficial branch perforator (SCISP) flap was introduced to standardize the surgical technique for using only perforators of the superficial branch of the SCIA as free flaps.The SCISP flap is safe and viable for total autologous breast reconstruction, particularly for women with small to medium sized breasts and with superficial dominance of the abdominal vascular system.

Microsurgical Reconstruction with and without Microvascular Anastomosis of Oncological Defects of the Upper Limb.

The choice of the most adequate surgical technique for upper limb defects remains challenging. The aim of this article is to discuss the main microsurgical (pedicled or free) reconstructive options for the post-oncological reconstruction of different anatomical areas of the upper extremity. We reviewed different reconstructive methods reported in the literature needing microsurgical expertise and compared them to our clinical experience, in order to provide further guidance in the choice of different flaps for upper limb soft tissue reconstruction. Six clinical cases, one for each anatomical district, are presented as examples of possible solutions. We report the options available in the literature for post-oncologic upper limb reconstruction, dividing them by anatomical area and type of flap: local flaps, regional flaps, free flaps, and distant pedicled flaps. Our examples of the reconstruction of each anatomical area of the upper limb include one reverse ulnar pedicled perforator flap, one free Antero-Lateral Thigh (ALT) flow-through flap, one perforator-based lateral arm flap, two myocutaneous latissimus dorsi pedicled flaps, and one parascapular perforator-plus flap. In oncological cases, it is important to consider reconstructive options that provide stable tissue and allow for the early healing of the donor and recipient site if the patient needs to undergo adjuvant radiotherapy or chemotherapy. A wider range of flap options is essential when choosing the proper technique according to the patient's needs, surgeon's preference, and logistical possibilities. Perforator flaps combine the advantages of other flaps, but they require microsurgical expertise. Free flap reconstruction remains the gold standard to obtain a better overall and cosmetic outcome in complex and wide defects, where no suitable local pedicled flap option exists. The pedicled latissimus dorsi flap should still be included among the reconstructive options for its strong vascularization, size, and arc of transposition.

The Imageology Study and Clinical Application of Perforating Branch of Posterior Tibial Artery.

It is necessary to precisely locate the branches for better result of flap transplantation for the high variability of perforating branches of posterior tibial artery (PTA). In the research, digital subtraction angiography (DSA) and high-frequency ultrasound are jointly used to study the distribution and exact location of PTA perforating branches to guide clinical practice. From January 2020 to December 2022, 16 patients underwent DSA examination and 5 of them accepted further high-frequency ultrasound examination. The authors analyzed the distribution, number, location, direction, and lengths of PTA branches and used PTA perforator flaps to repair middle and inferior lower leg defects according to the above imaging findings. The donor site was repaired with skin grafts or a sequential PTA perforator flap. A total of 81 branches of PTA were identified in 16 patients. Most of the perforating branches were in the middle and distal thirds of tibia. There was a significant correlation between the length of perforating branches and their perforating sites. Cluster analysis showed that larger branches appeared most frequently in the range of 15 to 20cm from the tip of the inner ankle. 5 cases of PTA perforator flaps survived well. DSA can clearly show the distribution of PTA and its branches, especially the dominant ones. The imaging findings can effectively guide PTA perforator flap design and harvesting, and thus improve the result of flap transplantation.

Results of innervated digital artery perforator flap and direct-flow homodigital flap application in fingertip soft tissue amputations

ObjectiveThe purpose of this study is to compare the results of the innervated digital artery perforator (IDAP) flap and the direct-flow homodigital flap as reconstruction methods for fingertip soft tissue amputations. This issue is important in hand surgery, and we aim to identify the method that provides the best functional and cosmetic outcomes.MethodsBetween 2020 and 2022, 32 patients with fingertip amputations were reconstructed by the same surgeon using two different methods. The patients were retrospectively divided into two groups: those who underwent IDAP (n = 14) and those who had a direct-flow homodigital flap (n = 18). We compared the groups in terms of defect size, cold intolerance, venous congestion, Sollerman hand function test scores, Seddon sensory test scores, and follow-up periods, as well as flap viability, flexion contracture, and static two-point discrimination (s2PD).ResultsOf the 32 patients (26 men, 6 females; age: mean 28.72 ± 11.5 years), the injuries were caused by different mechanisms, including sharp (57.1% IDAP), crush (75% IDAP) and entanglement (66.7% homodigital). The average area of tissue loss was approximately 2.70 ± 1.37 cm², while the average s2PD measurement was approximately 4.94 ± 1.04 mm. Postoperatively, the Seddon sensory test results for the homodigital flap group were S4 (61.5%), S3 (23.1%), S3+ (7.7%), and S2 (7.7%), compared to the IDAP group, which showed S4 (57.9%), S3+ (21.1%), and S3 (21.1%). Complications occurred in five patients, though no flap loss or revision was required. The postoperative mean Sollerman hand function scores were higher for the homodigital group than for the IDAP group, with values of 75 ± 2.64 and 73 ± 3.34, respectively. Although not statistically significant, the results numerically suggest that the IDAP flap is better in terms of sensory recovery and hand function compared to the homodigital flap (p > 0.05).ConclusionsThis is the first investigation to compare direct-flow flaps with IDAP. The average follow-up period for patients who underwent homodigital surgery was also shorter than that of the IDAP group. Furthermore, the mean postoperative two-point discrimination and postoperative Sollerman function score were higher in patients who had homodigital surgery.

Evaluation of the donor Site morbidity following harvesting of thoracodorsal artery perforator flap

Evaluation of the donor Site morbidity following harvesting of thoracodorsal artery perforator flap

Computed Tomographic Angiography in Planning Thoraco-dorsal Artery Perforator Flap in Breast and Soft Tissue Reconstruction: A Systematic Review.

Thoraco-dorsal Artery Perforator (TDAP) flaps have been increasingly used in breast and soft tissue reconstruction. Perforator localization is often done using a hand-held doppler, however, false results are not uncommon. This study aimed to systematically review the literature on the value of preoperative Computed Tomographic Angiography (CTA) in TDAP flaps examining scanning protocol, mapping technique, concordance with operative findings and disadvantages. A PRISMA-compliant comprehensive search of Medline, Embase, Cochrane Library and CINAHL databases was conducted in November 2023. We included studies evaluating CTA mapping of free and pedicled TDAPs for breast or soft tissue reconstruction using The Joanna Briggs Institute (JBI) Critical Appraisal Tools. Five studies were included and considered at high risk of bias. The studies included 72 patients with a mean age of 43.8 years. Concordance between CT findings and Doppler mapping or operative visualization was reported in two studies. In three studies, CTA was combined with Doppler flowmetry, whilst dynamic infrared thermography was used in one study. Standardized scanning protocol and patient positioning were lacking in all reports. This study highlights the paucity of evidence on the value of CTA in TDA perforator mapping with inconsistent outcomes and non-standardized scanning protocols. Despite difficult imaging acquisition and interpretation, 3D reconstructed images and detailed vascular anatomy may facilitate planning. Further research is required to explore the practical value of CTA in TDAP planning and standardizing protocols.

Superiorly Based Preauricular Tunneled Perforator Flap for Anterior Auricular Surface Defects

Superiorly Based Preauricular Tunneled Perforator Flap for Anterior Auricular Surface Defects

Clinical effects of different types of flaps selected according to local conditions in the treatment of diabetic foot defects

BackgroundThe repair of diabetic foot defects (DFD) is a major challenge in clinical practice. The purpose of this study was to investigate the difference in clinical efficacy of different flap techniques in repairing DFD wounds, and to compare the difference in clinical efficacy of anterolateral thigh perforator flap (ALTP) in repairing DFD and non-DFD.MethodsThis study is a retrospective clinical study of different types of flap reconstruction in patients with DFD admitted to our hospital from January 2010 to December 2021. A total of 40 patients with DFD and 43 patients with non-DFD were included in this study. Detailed preoperative basic information, intraoperative details, postoperative complications and long-term follow-up results were collected.ResultThe comorbidities, wound infection and wound duration of DFD group were more serious than those of non-DFD group. In addition, the incidence of complications was higher in DFD group, the wound healing time was longer, the aesthetic evaluation, the functional recovery rate of ankle joint and the sensory recovery effect of flaps were worse.ConclusionIn this study, it is concluded that different flap techniques can obtain better clinical efficacy in repairing DFD wounds. Compared with non-DFD wounds, the postoperative risk of DFD wounds using free ALTP flaps is higher, but the risk can be reduced by reasonable preoperative vascular examination. Free flap can deal with various irregular wounds and provide more options for clinical repair.Level of evidenceIII, Case–control study.

On a hunt for the "true" septocutaneous perforator - a histology cross section study.

Modern trends in reconstructive surgery involve the use of free perforator flaps to reduce the donor site morbidity. The course of perforator vessels has a great anatomic variability and demands a careful knowledge of the anatomical relationships and the variability of the course of the perforators. The numerous modifications of perforator nomenclature were proposed by many authors and brought confusion rather than a simplification. In our study we focused on a hypothesis, that septocutaneous perforator passes from the given source vessel to the deep fascia adherent to, but not to within the septum itself. 69 septocutaneous perforators from three different limb donor sites (Lateral Arm Flap, Anterolateral Thigh Flap, Radial Forearm Free Flap) were collected from gross pathology specimens of 14 fresh cadavers. The gross picture and the cross sections with the histological cross sections on different levels were examined to determine the position of vessel to the septal tissue. Of the observed 69 septal perforators, 61 (88,5%) perforators were adherent to but not within the septum. Remaining eight (12,5%) perforators passed through the septum. All these eight perforators were found in multiple different cross section levels. (two of 19 in Lateral Arm Flap, three of 27 in Anterolateral Thigh Flap, three of 23 in Radial Forearm Free Flap). Although macroscopically identical septocutaneous vessels, microscopically we observe two types of vessels - with paraseptal and intraseptal pathways. The majority are merely adherent to the septum having a paraseptal pathway. A minority are within the septum, and are "true" septocutaneous perforators. It is advisable to dissect with a piece of the septum in order to avoid damage any injury of perforator.

The free style “Twin V/Y Nasal Perforator Flaps”. An alternative to the forehead flap for nasal tip reconstruction. A case control study

IntroductionReplacing the skin along the nasal tip remains a challenge.Depending on the extent of the skin loss different local or regional flaps are available for reconstruction. If cutaneous replacement involves the nasal tip, the forehead flap can be used successfully. However, it requires a multi-stage procedure and can leave considerable scarring on the patient’s forehead. As an alternative, the authors present the free style “Twin V/Y Nasal Perforator Flaps” (TVYNPF), which can be used as a one-stage procedure for nasal tip reconstruction. Material and MethodsA series of five patients aged between 69 and 89 years with extensive basal cell carcinomas (BCC) at the nasal tip are presented (Table 1). The surgical procedure is explained in detail. Follow up ranged from 8 to 12 months. ResultsHealing was uneventful for all five patients and the shape, symmetry and aesthetical unity of the nasal tip and the alae of the nose were preserved in all patients without any functional impairment. All scars presented inconspicuous. ConclusionIn selected patients the free style TVYNPF proved to be a good alternative to the forehead flap for one-stage reconstruction of significant skin loss along the nasal tip, while preserving the aesthetics and function of the nose.

Embracing Robotics in Microsurgery: Robotic-Assisted Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

The integration of robotic-assisted surgery (RAS) has transformed various surgical disciplines, including more recently plastic surgery. While RAS has gained acceptance in multiple specialties, its integration in plastic surgery has been gradual, challenging traditional open methods. Robotic-assisted deep inferior epigastric perforator (DIEP) flap breast reconstruction is a technique aimed at overcoming drawbacks associated with the traditional open DIEP flap approach. These limitations include a relatively large fascial incision length, potentially increasing rates of postoperative pain, abdominal bulge, hernia rates, and core weakening. The robotic-assisted DIEP flap technique emerges as an innovative and advantageous approach in fascial-sparing abdominal autologous breast reconstruction. While acknowledging certain challenges such as increased operative time, ongoing refinements are expected to further improve the overall surgical experience, optimize results, and solidify the role of robotics in advancing reconstructive microsurgical procedures in plastic surgery. Herein, the authors provide an overview of robotic surgery in the context of plastic surgery and its role in the DIEP flap harvest for breast reconstruction.

The lumbar artery perforator free flap as an alternative option for breast reconstruction in low BMI patients: analysis of CT Angiography of donor sites across BMI.

In patients with a low body mass index (BMI), the options for autologous breast reconstruction are limited. With the hypothesis that adipose tissue deposition persists in the lumbar region compared to the abdominal wall, this study sought to investigate the lumbar artery perforator (LAP) free flap as an alternative reconstructive option in patients with deficient autologous donor sites consequent to a low BMI. A retrospective cohort analysis was performed, from a prospectively maintained database, of all consecutive DIEP flap breast reconstructions performed in our unit. A randomized selection of 100 patients with low BMI <22, normal BMI 22-24 and high BMI >30 was performed. Patient computerized tomography scans were analyzed to measure abdominal wall and lumbar tissue thickness and to define anatomical landmark relations of the lumbar artery perforator. A statistically significant difference was identified between the ratio of lumbar to abdominal wall thickness between BMI groups, highlighting preservation of the lumbar thickness in patients with low BMI. The mean distance at which the fourth lumbar perforator entered the subcutaneous tissues was 7.7cm lateral to the spinous process (range 6.4 - 9.5cm), with no significant difference between BMI groups, highlighting this consistent anatomical position. This study confirms a greater lumbar to abdominal wall thickness, therefore volume, in low BMI patients, with consistent lumbar perforator anatomy of 6.4 - 9.5cm lateral to the spinous process. The lumbar artery perforator flap should therefore be strongly considered for autologous breast reconstruction in this patients with a low BMI.

A Meta-analysis Comparing Deep Inferior Epigastric Perforator Flaps and Latissimus Dorsi Flaps in Breast Reconstruction.

Deep inferior epigastric perforator (DIEP) flaps and latissimus dorsi (LD) flaps are two widely used breast reconstruction techniques, each with distinct advantages and limitations. This meta-analysis aims to compare patient satisfaction and incidence of complications between these two techniques to inform clinical decision-making. PubMed, Scopus, and Web of Science were searched for relevant studies. We included studies with data comparing DIEP and LD flaps, BREAST-Q patient satisfaction, and complications. Statistical analyses were performed using RevMan 5.4. The search yielded 788 studies, of which 13 were included in the meta-analysis. A total of 2128 patients were analyzed, with 1378 undergoing DIEP flap reconstruction and 750 receiving LD flap reconstruction. The analysis showed greater improvement with DIEP flaps in breast satisfaction [mean difference (MD) = 9.48, 95% confidence interval (CI) = 6.90-12.05, P < 0.00001], physical well-being (MD = 5.95, 95% CI = 2.98-8.92, P < 0.0001), and satisfaction with outcome (MD = 9.36, 95% CI = 3.01-15.71, P = 0.004). Nonetheless, DIEP flaps had higher rates of skin flap necrosis [risk ratio (RR) = 4.27, 95% CI = 2.44 to 7.46, P < 0.00001], wound dehiscence (RR = 5.12, 95% CI = 2.53-10.35, P < 0.00001), and reoperation (RR = 2.24, 95% CI = 1.58 -3.16, P < 0.00001) but lower seroma rates (RR = 0.27, 95% CI = 0.10-0.74, P = 0.01). DIEP flap reconstruction offers superior patient satisfaction compared with LD flap reconstruction, despite a higher incidence of certain complications.

Quality of Video Content Related to Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Social Media Platforms Versus Large Language Models.

The deep inferior epigastric perforator (DIEP) flap is currently one of the main options in breast reconstruction. The information about this surgery is critical for the patient, in order to choose the breast reconstruction method. Our study aims to analyze and compare the quality and accuracy of the information related to the DIEP flap reconstruction method provided by social media platforms (SMPs) and the new large language models (LLMs). A total of 50 videos in English and Spanish were selected from the main SMPs (YouTube, Instagram, and Facebook) using the keywords "DIEP flap" and "colgajo DIEP." The duration, number of likes, dislikes, number of visits, upload date, author, and the video category (institutional video, media, patient experience, academic, and surgery) were analyzed. 3 specific questions were asked to 2 new LLMs (ChatGPT and Google Bard). The quality of information in SMPs and LLMs was analyzed and compared by 2 independent board-certified plastic surgeons using the Journal of American Medical Association and DISCERN scales. LLMs showed a statistically significant higher quality of information when compared with SMPs based on the DISCERN scores. The average DISCERN scores for answers given by ChatGPT and Google Bard were 54 ± 6.841 and 61.17 ± 6.306, respectively (good quality). In SMPs, the average scores were 2.31 ± 0.67 (insufficient quality) and 32.87 ± 9.62 (low quality) for the Journal of American Medical Association and DISCERN scales respectively. Thirty-eight percent of the videos in SMPs were performed by nonmedical authors. The quality of information for breast reconstruction using DIEP flaps from LLMs was considered good and significantly better than in SMPs. The information found in SMPs was insufficient and of low quality. Academic plastic surgeons have an opportunity to provide quality content on this type of reconstruction in LLM and SMPs.