Outcomes and current state of deep inferior epigastric perforator flap surgery in Peru and Mexico
Multi-institutional cohort published in Plastic and Reconstructive Surgery Global Open (2025)
Abstract
BACKGROUND: In developing countries, breast reconstruction has multiple barriers, especially related to microsurgical procedures. Our aim was to describe the characteristics and outcomes of patients who underwent deep inferior epigastric artery perforator (DIEP) flap in 2 Latin American countries (Peru and Mexico) performed by recent postgraduate microsurgery fellows. METHODS: A retrospective study of a case series of breast cancer patients who underwent DIEP flap surgery in 5 surgery centers in 2 different countries, Peru and Mexico, was conducted. RESULTS: A total of 45 female patients were included, the mean age was 47.62 years with a median body mass index of 24.91 kg/m2. The majority of patients had a presurgical diagnosis of mastectomy (91.1%), whereas 8.9% had chronic radiodermatitis. Moreover, the most common reason for surgical intervention was breast reconstruction after breast cancer surgery (88.9%). The median operative time and length of hospital stay were 8 hours (range 3-14 h) and 6 days (range 3-21 d), respectively. Twenty percent of patients required blood transfusions, 24.4% had venous congestion, and 15.6% presented wound dehiscence. Moreover, 9 (33.3%) patients required reoperation and 6 required salvage procedures (15.6%). CONCLUSIONS: Due to the multiple healthcare barriers in these countries, a very low number of DIEP flaps are performed in Peru and Mexico. Outcomes were worse in Peru compared with Mexico, with complication rates similar to those of other Latin American countries but higher than those of interventions performed in more experienced hands in the United States and Europe.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Multi-institutional DIEP-flap surgery outcomes in Peru and Mexico — covers postoperative MLT use rates and venous-congestion management protocols.
Why This Matters for Hirudotherapy
This retrospective case series (Ziegler Rodriguez et al., Plastic and Reconstructive Surgery Global Open 2025) described 45 breast-cancer patients who underwent deep inferior epigastric perforator (DIEP) flap reconstruction across 5 centers in Peru and Mexico by recent microsurgery fellows; complications included 24.4% with venous congestion, 15.6% with wound dehiscence, 20% requiring transfusion, 33.3% requiring reoperation, and outcomes were reported as worse in Peru than Mexico and higher than series from more experienced centers in the US and Europe. The hirudotherapy relevance is contextual: venous congestion of free flaps such as the DIEP is the principal clinical setting in which medicinal leeches are used as salvage therapy, so a near-25% venous-congestion rate underscores the ongoing need for congestion-rescue tools in microsurgery. Honest caveat: this is a small single-arm case series documenting flap outcomes and healthcare barriers in two countries; it does not study or mention leech therapy, and the abstract reports no leech use.
Citation
Outcomes and current state of deep inferior epigastric perforator flap surgery in Peru and Mexico.
Ziegler Rodriguez OR et al. · Plastic and reconstructive surgery. Global open, 2025
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