Perforator-Related Risk Factors for Perfusion-Related Complications in DIEP Flap Breast Reconstruction

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.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

In 292 unilateral DIEP flap breast reconstructions, perfusion-related complications occurred in 24.7%; multivariate analysis identified the shortest perforator-to-flap-edge distance as the significant risk factor, with ROC analysis giving a critical threshold of 42.5 mm to guide flap design.

Explore how this research connects to clinical practice

More peer-reviewed studies in Clinical Literature.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• Efficacy and Safety of Hirudotherapy for Improving Sperm Quality Parameters in Male Infertility: A Randomized Controlled Trial — Abtahi-Forooshani M et al. (2026)
• Reverse Sural Flap Venous Congestion Successfully Managed With Enoxaparin in a Male Patient With a Traumatic Foot Crush Injury: A Case Report — Velasco-Bustamante J et al. (2026)
• Investigation of the therapeutic effects of medicinal leech treatment on lower extremity ischemia-reperfusion injury — Ünal K et al. (2026)
• Efficacy of Medicinal Leech Therapy in Diverse Clinical Applications: A Comprehensive Study from Azerbaijan — Farzali S et al. (2025)
• HIRUDOTHERAPY IN RECONSTRUCTIVE SURGERY: CASE-REPORTS AND REVIEW — Heinz P et al. (2020)
• Hirudotherapy in Wound Healing — Nair H et al. (2022)
• Hirudotherapy for limb ischemia in the pediatric intensive care unit: A retrospective observational cohort — Resch J et al. (2022)

Browse all ASH-analysed research →