From the Department of Plastic, Reconstructive, and Hand Surgery.
GROW School for Oncology and Developmental Biology, Maastricht University Medical Center.
Plast Reconstr Surg. 2024 Jun 1;153(6):1063e-1072e. doi: 10.1097/PRS.0000000000010837. Epub 2023 Jun 19.
The delay procedure in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, in which the reduced-caliber choke vessels play a major role, can provide more well-perfused tissue than a standard DIEP flap. The aim of this study was to review the authors' experience with this technique, evaluate the indications, and analyze the surgical outcomes.
A retrospective study was conducted of all consecutive DIEP delay procedures performed between March of 2019 and June of 2021. Patient demographic characteristics, operative details, and complications were registered. Patients had preoperative imaging by magnetic resonance angiography to select dominant perforators. The surgical technique involves a two-stage operation. During the first operation, the flaps were pedicled on a dominant perforator and a lateral skin bridge extending toward the lateral flank and lumbar fat; in a second stage, the flap was harvested and transferred.
A total of 82 extended DIEP delay procedures were performed to reconstruct 154 breasts. The majority were bilateral breast reconstructions (87.8%). The delay procedure was used for 38 primary reconstructions (46.3%) and 32 tertiary reconstructions (39.0%). The primary indication was the need for additional volume (79.3%), followed by extensive abdominal scarring and liposuction. After the first operation, seroma was the most frequently observed complication (7.3%). After the second operation, three total flap losses (1.9%) were observed.
The delay procedure in DIEP flap breast reconstruction results in the harvest of a good amount of abdominal tissue by adding a preliminary procedure. This technique can convert cases previously considered unsuitable into suitable candidates for abdominal-based breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
在深下腹直肌穿支皮瓣（DIEP）乳房再造中，延迟程序中缩窄的吻合血管发挥着重要作用，比标准 DIEP 皮瓣能提供更充分灌注的组织。本研究旨在回顾作者的经验，评估适应证，并分析手术结果。
回顾性分析 2019 年 3 月至 2021 年 6 月期间连续进行的所有 DIEP 延迟手术。记录患者的人口统计学特征、手术细节和并发症。患者行术前磁共振血管造影以选择优势穿支。手术技术分两期进行。一期手术时，皮瓣以优势穿支为蒂，向外侧皮桥延伸至侧腰部和腰部脂肪；二期手术时，皮瓣被采集和转移。
共进行了 82 例扩展 DIEP 延迟手术，重建了 154 个乳房。大多数为双侧乳房重建（87.8%）。延迟手术用于 38 例初次重建（46.3%）和 32 例再次重建（39.0%）。主要适应证是需要额外的体积（79.3%），其次是广泛的腹部瘢痕和吸脂。一期手术后，最常观察到的并发症是血清肿（7.3%）。二期手术后，观察到 3 例总皮瓣失活（1.9%）。
DIEP 皮瓣乳房再造中的延迟程序通过添加初步程序，可收获大量腹部组织。该技术可将先前认为不适合的病例转化为适合腹部为基础的乳房再造的候选者。
临床问题/证据水平：治疗性，IV。
