Dept. of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625 Düsseldorf, Germany.
Dept. of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, D-40625 Düsseldorf, Germany; Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf.
J Plast Reconstr Aesthet Surg. 2024 May;92:11-25. doi: 10.1016/j.bjps.2024.02.059. Epub 2024 Feb 28.
Total deep inferior epigastric perforator (DIEP) flap failure is a significant concern in autologous breast reconstruction. Literature on secondary reconstruction options following total flap failure is limited. This study outlines the outcomes of patients who underwent reconstruction post-DIEP flap failure at our institution.
We conducted a retrospective analysis of patients receiving autologous breast reconstruction between 2004 and 2021. We aimed to identify causes of total DIEP flap failure, outcomes of revision surgery, and outcomes of secondary breast reconstruction procedures.
From 2004 to 2021, 3456 free flaps for breast reconstruction were performed, with 3270 being DIEP flaps for 2756 patients. DIEP flap failure was observed in 40 cases (1.22%). Bilateral reconstructions had a higher failure rate (2.31%) than unilateral (0.72%). The primary cause was intraoperative complications during flap harvest (18 cases), followed by insufficient arterial perfusion (seven cases). Other causes included postoperative hematoma (seven cases), venous congestion (six cases), and late-onset fat necrosis (two cases). Post-failure, five patients received a second free flap with three cases of repeated flap failure. Twenty patients received implant-based reconstruction with two cases of reconstruction failure, while seven patients received a pedicled latissimus dorsi (LD) flap reconstructions with no cases of reconstruction failure. Eight patients declined further reconstruction.
A second free flap post-DIEP failure was associated with a high risk of reconstruction failure, suggesting the need for careful patient selection. Implant-based and pedicled LD flap seem to be reliable secondary reconstruction options.
全腹壁下动脉穿支（DIEP）皮瓣失败是自体乳房重建中的一个重大问题。关于全皮瓣失败后的二次重建选择的文献有限。本研究概述了在我们机构接受 DIEP 皮瓣失败后重建的患者的结果。
我们对 2004 年至 2021 年间接受自体乳房重建的患者进行了回顾性分析。我们旨在确定全 DIEP 皮瓣失败的原因、修复手术的结果以及二次乳房重建手术的结果。
2004 年至 2021 年期间，共进行了 3456 例游离皮瓣乳房重建，其中 3270 例为 2756 例患者的 DIEP 皮瓣。40 例（1.22%）发生 DIEP 皮瓣失败。双侧重建的失败率（2.31%）高于单侧重建（0.72%）。主要原因是皮瓣采集过程中的术中并发症（18 例），其次是动脉灌注不足（7 例）。其他原因包括术后血肿（7 例）、静脉淤血（6 例）和迟发性脂肪坏死（2 例）。失败后，5 例患者接受了第二次游离皮瓣，其中 3 例重复皮瓣失败。20 例患者接受了基于植入物的重建，其中 2 例重建失败，而 7 例患者接受了带蒂背阔肌（LD）皮瓣重建，无重建失败病例。8 例患者拒绝进一步重建。
DIEP 皮瓣失败后再次进行游离皮瓣与重建失败的高风险相关，提示需要仔细选择患者。基于植入物和带蒂 LD 皮瓣似乎是可靠的二次重建选择。
