Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California.
J Reconstr Microsurg. 2019 Jul;35(6):411-416. doi: 10.1055/s-0038-1677013. Epub 2019 Jan 7.
Deep inferior epigastric perforator (DIEP) flaps are routinely elevated on a single dominant perforator from the deep epigastric vascular system. However, the single perforator may not always perfuse an entire flap adequately, particularly suprascarpal tissue. We often perform "dual-plane" single perforator DIEP flaps by rerouting the superficial (SIEA/V) system directly into a branch of the deep (DIEA/V) vascular system pedicle, thus allowing both systems to contribute and enhance flap perfusion.
A prospectively collected database of patients undergoing microvascular breast reconstruction was reviewed for patients undergoing "dual-plane" DIEP flaps. These were matched to a similar cohort of patients undergoing "traditional" single perforator DIEP free flaps over the same time period. Treatment demographics and flap-specific morbidity outcomes were assessed, including performance in the setting of radiation.
Over 2 years, 23 "dual-plane" DIEP flaps were performed (15 patients), compared with 35 single-perforator "traditional" DIEP flaps (23 patients). Rates of delayed healing were similar between both cohorts (2.9 vs. 4.3%, = 0.28). Rates of palpable fat necrosis were significantly lower in "dual-plane" DIEP flaps compared with "traditional" flaps (0 vs. 14.3%, = 0.03). Rates of clinically palpable fat necrosis following radiation were significantly lower in the "dual-plane" flaps (4.3 vs. 40%, = 0.02).
The "dual-plane" DIEP flap is one we routinely consider in our algorithm, as it allows for full preservation of functional abdominal musculature, and offers enhanced flap perfusion by incorporating both the deep and superficial (dominant) vascular systems. This results in lower fat necrosis rates, particularly in the setting of post-reconstruction radiation.
深下腹上动脉穿支（DIEP）皮瓣通常在深腹部血管系统的单个优势穿支上提起。然而，单个穿支并不总是能充分灌注整个皮瓣，特别是超掌侧组织。我们经常通过将浅层（SIEA/V）系统直接重新引导到深部（DIEA/V）血管系统蒂的分支来进行“双平面”单穿支 DIEP 皮瓣，从而允许两个系统都参与并增强皮瓣灌注。
回顾了接受微血管乳房重建的患者的前瞻性收集数据库，以寻找接受“双平面”DIEP 皮瓣的患者。这些患者与同一时期接受“传统”单穿支 DIEP 游离皮瓣的类似患者进行了匹配。评估了治疗人口统计学和皮瓣特异性发病率结果，包括在放射治疗环境下的表现。
在 2 年期间，共进行了 23 例“双平面”DIEP 皮瓣（15 例患者），与 35 例单穿支“传统”DIEP 皮瓣（23 例患者）相比。两组延迟愈合率相似（2.9%与 4.3%，=0.28）。与“传统”皮瓣相比，“双平面”DIEP 皮瓣中可触及的脂肪坏死率明显更低（0 与 14.3%，=0.03）。在“双平面”皮瓣中，接受放射治疗后临床可触及的脂肪坏死率明显更低（4.3%与 40%，=0.02）。
“双平面”DIEP 皮瓣是我们在算法中常规考虑的一种皮瓣，因为它允许完整保留腹部功能肌肉，并通过结合深部和浅层（优势）血管系统来提供增强的皮瓣灌注。这导致脂肪坏死率降低，特别是在重建后放射治疗的情况下。
