Is there a way to reduce complication rates during DIEP flap breast reconstruction?
A study conducted at PRMA and published in Plastic & Reconstructive Surgery Global Open, finds that the use of a second vein during DIEP flap surgery, a procedure that rebuilds the patient’s breasts after mastectomy using her own tummy skin and fat, can significantly reduce the risk of flap loss and other DIEP flap complications.
“Sometimes we come across patients that develop what we call congestion in the DIEP flap” says Dr. Steven Pisano of PRMA. “When this happens, the flap turns purple. This basically means that blood is getting into the flap but is pooling in the tissue instead of flowing back out. This “back-up” of blood increases the risk of flap complications like fat necrosis, partial loss and even complete failure of the reconstruction.”
Pisano says that the use of a second ‘exit-vein’ so to speak, allows the surgeon to save the flap and ensure a successful breast reconstruction.
The study, which analyzed 1616 patients, showed that the percentage of cases where the surgeon had to use the second vein was about 3.3%. Dr. Pisano said however, that since the publication of the paper, the percentage of flaps where a second vein is used is now 5-10% because the surgeons have gained further experience recognizing the very earliest, most subtle signs of venous congestion.
“What our study has taught us is that if we now notice during surgery that the patient’s blood vessels may not support the flap, we go ahead and use a second vein,” said Pisano. “This prevents the possibility of flap loss within the first couple of days after surgery due to congestion that wasn’t obvious in the operating room.”
PRMA is one of the largest plastic surgery groups in the US specializing in breast reconstruction. PRMA specializes in microsurgical flap procedures like the DIEP flap that use only the patient’s skin and fat while preserving muscle. PRMA performs over 700 DIEP flaps per year with a success rate over 99%.
Author: Brandy Haslam and Dr. Minas Chrysopoulo
What our study has taught us is that if we now notice during surgery that the patient’s blood vessels may not support the flap, we go ahead and use a second vein.
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