Umbilical Complications following DIEP Flap Breast Reconstruction: Demonstrating the Added Benefit of Preoperative Imaging.
Research article published in Plastic and reconstructive surgery (2022)
Abstract
BACKGROUND: Despite the umbilicus being an essential aesthetic unit, current literature on umbilical outcomes following abdominally based breast reconstruction is limited. In this study, the authors aim to elucidate the incidence and predictors of umbilical complications following deep inferior epigastric perforator (DIEP) flaps, with a particular emphasis on past abdominal surgery by type and measures that can be obtained easily from preoperative imaging. METHODS: An institutional review board-approved retrospective review of 258 patients who underwent DIEP flap reconstruction from 2011 through 2020 was performed. Patient demographics, preoperative laboratory studies, and intraoperative factors were appraised. Preoperative computed tomographic angiography or magnetic resonance angiography was used to measure umbilical stalk height (SH), abdominal wall thickness (AWT), and total fascial diastasis. Patients with and without perfusion-related umbilical complications were compared. RESULTS: Forty patients (15.5%) developed umbilical complications, including 20 patients with epidermolysis or scab, 12 with dehiscence, and 14 with partial necrosis. Patients with complications had a significantly higher rate of hypertension, previous abdominal midline incision, more lateral perforators per flap, longer umbilical stalk, and larger SH/AWT ratio ( P < 0.05). Logistic regression revealed that SH ( P = 0.006) and SH/AWT ratio ( P < 0.001) were the only significant predictors, with the latter having a greater area under the receiver operating characteristic curve (area under the curve, 0.79; P < 0.001). CONCLUSIONS: Radiographic measurements of umbilical SH and SH/AWT ratio reliably predict the occurrence of umbilical complications, with the ratio having a more robust predictive ability. The authors propose the use of routine preoperative imaging to identify high-risk patients who may benefit from prophylactic measures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Despite the umbilicus being an essential aesthetic unit, current literature on umbilical outcomes following abdominally based breast reconstruction is limited. In this study, the authors aim to elucidate the incidence and predictors of umbilical complications following deep inferior epigastric...
Why This Matters for Hirudotherapy
This retrospective study examined umbilical complications following deep inferior epigastric perforator (DIEP) flap breast reconstruction in 258 patients, finding that radiographic measurements of umbilical stalk height and the stalk-height-to-abdominal-wall-thickness ratio were significant predictors of complications such as dehiscence and partial necrosis. The authors propose routine preoperative imaging to identify high-risk patients. For ASH's domain, this article has no defensible connection to hirudotherapy or the leech secretome; it concerns surgical reconstruction outcomes and preoperative imaging. The study involves no leeches, leech-derived compounds, or anticoagulation strategies relevant to leech therapy, and its findings bear no relevance to ASH's research interests.
Citation
Umbilical Complications following DIEP Flap Breast Reconstruction: Demonstrating the Added Benefit of Preoperative Imaging.
Huang et al. · Plastic and reconstructive surgery, 2022
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