Perforator-Related Risk Factors for Perfusion-Related Complications in DIEP Flap Breast Reconstruction
SUMMARY: Introduction: Despite the advancements in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, perfusion-related complications (PRCs) remain a concern. Such complications can negatively impact the aesthetic outcome, necessitate revisional surgery and delay adjuvant...
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Elsevier
2025-06-01
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| author | Dernas Suhail (DS) Ryan Faderani (RF) Afshin Mosahebi (AM) Augustine Akali (AA) |
| author_facet | Dernas Suhail (DS) Ryan Faderani (RF) Afshin Mosahebi (AM) Augustine Akali (AA) |
| author_sort | Dernas Suhail (DS) |
| collection | DOAJ |
| description | SUMMARY: Introduction: Despite the advancements in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, perfusion-related complications (PRCs) remain a concern. Such complications can negatively impact the aesthetic outcome, necessitate revisional surgery and delay adjuvant chemotherapy and radiotherapy. The aim of this study was to investigate the impact of perforator diameter, perforator row, and the shortest distance between the perforator and flap edge on the development of PRCs in DIEP flap breast reconstruction. Methods: This cohort study prospectively analysed the stored data for consecutive patients who underwent unilateral DIEP flap breast reconstruction from January 2008 to January 2023. Variables with p<0.25 in univariate analysis were included in multivariate logistic regression analysis to identify the risk factors for PRCs. p<0.05 was deemed statistically significant. Receiver operating characteristic (ROC) curve analysis was conducted to identify the critical distance between the perforator and flap edge distinguishing the PRCs. Results: V Overall, 292 cases of unilateral DIEP flap breast reconstruction were identified, with a mean patient age of 52.6 years. PRCs occurred in 72 cases (24.7%). Multivariate logistic regression identified the shortest distance between the perforator and flap edge that has a significant impact on PRC incidence. ROC curve analysis found the critical shortest distance between the perforator and flap edge distinguishing PRCs to be 42.5 mm. Conclusions: This study showed that the shortest distance between the perforator and flap edge is a strong predictor for PRCs in DIEP flap breast reconstruction. As several perforator characteristics are considered when designing and performing DIEP flap breast reconstruction, these findings can guide surgeons in this decision-making process. |
| format | Article |
| id | doaj-art-3e58404241c84985ad99b0e92a2de351 |
| institution | DOAJ |
| issn | 2352-5878 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JPRAS Open |
| spelling | doaj-art-3e58404241c84985ad99b0e92a2de3512025-08-20T03:13:29ZengElsevierJPRAS Open2352-58782025-06-014439040110.1016/j.jpra.2025.03.015Perforator-Related Risk Factors for Perfusion-Related Complications in DIEP Flap Breast ReconstructionDernas Suhail (DS)0Ryan Faderani (RF)1Afshin Mosahebi (AM)2Augustine Akali (AA)3Morriston Hospital, Swansea, UK, SA6 6NLDepartment of Surgery and Inteventional Sciences, University College London, London, UK, NW3 2PS; Corresponding author: Dr Ryan Faderani, Department of Surgery and Interventional Sciences, University College London, London, United Kingdom, (+44) 7714 230 424Department of Plastic Surgery, Royal Free Hospitals NHS Trust, London, UK, NW3 2QGDepartment of Plastic Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK, HU16 5JQSUMMARY: Introduction: Despite the advancements in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, perfusion-related complications (PRCs) remain a concern. Such complications can negatively impact the aesthetic outcome, necessitate revisional surgery and delay adjuvant chemotherapy and radiotherapy. The aim of this study was to investigate the impact of perforator diameter, perforator row, and the shortest distance between the perforator and flap edge on the development of PRCs in DIEP flap breast reconstruction. Methods: This cohort study prospectively analysed the stored data for consecutive patients who underwent unilateral DIEP flap breast reconstruction from January 2008 to January 2023. Variables with p<0.25 in univariate analysis were included in multivariate logistic regression analysis to identify the risk factors for PRCs. p<0.05 was deemed statistically significant. Receiver operating characteristic (ROC) curve analysis was conducted to identify the critical distance between the perforator and flap edge distinguishing the PRCs. Results: V Overall, 292 cases of unilateral DIEP flap breast reconstruction were identified, with a mean patient age of 52.6 years. PRCs occurred in 72 cases (24.7%). Multivariate logistic regression identified the shortest distance between the perforator and flap edge that has a significant impact on PRC incidence. ROC curve analysis found the critical shortest distance between the perforator and flap edge distinguishing PRCs to be 42.5 mm. Conclusions: This study showed that the shortest distance between the perforator and flap edge is a strong predictor for PRCs in DIEP flap breast reconstruction. As several perforator characteristics are considered when designing and performing DIEP flap breast reconstruction, these findings can guide surgeons in this decision-making process.http://www.sciencedirect.com/science/article/pii/S2352587825000567Perforator flapBlood supplyMammaplastyEpigastric arteriesFemale |
| spellingShingle | Dernas Suhail (DS) Ryan Faderani (RF) Afshin Mosahebi (AM) Augustine Akali (AA) Perforator-Related Risk Factors for Perfusion-Related Complications in DIEP Flap Breast Reconstruction JPRAS Open Perforator flap Blood supply Mammaplasty Epigastric arteries Female |
| title | Perforator-Related Risk Factors for Perfusion-Related Complications in DIEP Flap Breast Reconstruction |
| title_full | Perforator-Related Risk Factors for Perfusion-Related Complications in DIEP Flap Breast Reconstruction |
| title_fullStr | Perforator-Related Risk Factors for Perfusion-Related Complications in DIEP Flap Breast Reconstruction |
| title_full_unstemmed | Perforator-Related Risk Factors for Perfusion-Related Complications in DIEP Flap Breast Reconstruction |
| title_short | Perforator-Related Risk Factors for Perfusion-Related Complications in DIEP Flap Breast Reconstruction |
| title_sort | perforator related risk factors for perfusion related complications in diep flap breast reconstruction |
| topic | Perforator flap Blood supply Mammaplasty Epigastric arteries Female |
| url | http://www.sciencedirect.com/science/article/pii/S2352587825000567 |
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