Performing two DIEP flaps in a working day: an achievable and reproducible practice

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 63; no. 4; pp. 648 - 654
• Main Authors: Acosta, Rafael, Enajat, Morteza, Rozen, Warren M, Smit, Jeroen M, Wagstaff, Marcus J.D, Whitaker, Iain S, Audolfsson, Thorir
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.04.2010; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Breast reconstruction; Cardiovascular system; Computed tomographic angiography; Cook-Swartz probe; Deep inferior epigastric artery; Epigastric Arteries; Female; Follow-Up Studies; Humans; Implantable Doppler probe; Investigative techniques, diagnostic techniques (general aspects); Mammaplasty - methods; Mammaplasty - statistics & numerical data; Medical sciences; MEDICIN; MEDICINE; Middle Aged; Muscle, Skeletal - blood supply; Muscle, Skeletal - transplantation; Perforator flap; Plastic Surgery; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Reproducibility of Results; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps - blood supply; Time Factors; Treatment Outcome; Ultrasonic investigative techniques; Workload - statistics & numerical data; Cook–Swartz probe; Implantable Doppler probe; Computed tomographic angiography; Breast reconstruction; Deep inferior epigastric artery; Perforator flap; Sonography; Doppler ultrasound study; Radiodiagnosis; Angiography; Artery; Plasty; Treatment; Cook-Swartz probe; Surgery; Professional practice; Free flap; Breast; Medical imagery; Computerized axial tomography; Rectus abdominis muscle
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2009.01.015

Summary Background While the deep inferior epigastric artery perforator (DIEP) flap is a reliable technique for autologous breast reconstruction, the meticulous dissection of perforators may require lengthy operative times. In our unit, we have performed 600 free flaps for breast reconstruction over 8 years and have reduced operative times with a combination of preoperative computed tomographic angiography (CTA), various anastomotic techniques and the Cook–Swartz implantable Doppler probe for perfusion monitoring. We sought to assess the feasibility of performing two DIEP flaps within the working hours of a single day. Methods A review of 101 consecutive patients undergoing DIEP flap breast reconstruction in a 12-month period was performed, comparing one DIEP flap per day ( n = 43) to two DIEP flaps per day ( n = 58). Complications, outcomes and techniques used were critically analysed. For cases of two DIEP flaps per day, a comparison was made between the use of two separate operating theatres ( n = 44) and a single consecutive theatre ( n = 14). Results Complications did not increase when two DIEP flaps were performed in a single working day. The use of vascular closure staple (VCS) sutures and ring couplers resulted in statistically significant reductions in anastomotic times. The use of two separate theatres for performing two DIEP flaps resulted in a reduction of 59 min in operative time per case ( p = 0.004). Conclusion Two DIEP flaps can be safely and routinely performed within the hours of a single working day. By minimising operative times, these techniques can improve productivity and substantially decrease surgeon fatigue.