A New CT Analysis of Abdominal Wall after DIEP Flap Harvesting

Abstract

The abdominal microsurgical flap based on the deep inferior epigastric artery perforator (DIEP) flap has become the most popular option worldwide for autologous breast reconstruction. Several authors have investigated the results of reconstructed breasts, but the literature lacks systematic reviews exploring the donor site of the abdominal wall. To fulfil our aims, a new diagnostic muscle imaging analysis was designed and implemented. This study focused on rectus abdominal muscle morphology and function in a single series of 12 consecutive patients analysed before and after breast reconstruction with a microsurgical DIEP flap. Patients were divided into two groups, namely, "ipsilateral reconstruction" and "contralateral reconstruction", depending on the side of the flap harvest and breast reconstruction, then evaluated by computed tomography (CT) scans scheduled for tumor staging, and clinically examined by a physiatrist. Numerous alterations in muscle physiology were observed due to surgical dissection of perforator vessels, and rectus muscle distress without functional impairment was a common result. Postoperatively, patients undergoing "contralateral reconstruction" appeared to exhibit fewer rectus muscle alterations. Overall, only three patients were impacted by a long-term deterioration in their quality of life. On the basis of the newly developed and implemented diagnostic approach, we concluded that DIEP microsurgical breast reconstruction is a safe procedure without major complications at the donor site, even if long-term alterations of the rectus muscle are a common finding.

Keywords: CT; DIEP flap; abdominal wall; breast reconstruction; donor site morbidity; rectus muscle.

Figure 1

(a) Pt n# 11, preoperative transverse CT scan at sub-umbilical level; (b) pt n# 11, postoperative transverse CT scan at the same level. Red square brackets indicate the width of right rectus muscle belly (donor side of the DIEP flap).

Figure 2

(a) Pt n#12, preoperative transverse CT scan at sub-umbilical level; (b) pt n#12, postoperative transverse CT scan at the same level. Yellow dotted lines indicate the midline, and red dotted arrows indicate the linea alba between the recti muscles.

Figure 3

(a) Pt n#8, preoperative transverse CT scan at sub-umbilical level; (b) pt n#8, postoperative transverse CT scan at the same level. The red dotted line indicates the fascia above the recti muscles.

Figure 4

(a) Pt n#7, preoperative transverse CT scan at sub-umbilical level; (b) pt n#7, postoperative transverse CT scan at the same level. Red square brackets indicate the right rectus muscle thickness (donor site of the DIEP flap).

Figure 5

(a) Pt n#3, preoperative transverse CT scan at sub-umbilical level; (b) pt n#3, postoperative transverse CT scan at the same level. Red square brackets indicate the left rectus muscle thickness (contralateral site with respect to the donor side of the DIEP flap).