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.

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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.

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