Early Experience with Mesh Suture for DIEP Flap Abdominal Site Closures

Abstract

Background: The gold standard of microsurgical breast reconstruction is the deep inferior epigastric perforator (DIEP) free flap. As techniques have evolved, DIEP flaps have significantly reduced the morbidity previously caused by transverse rectus abdominis muscle (TRAM) and muscle-sparing TRAM flaps. However, abdominal wall complications continue to persist after DIEP flap surgery, with bulge rates reported as high as 33%.

Methods: The first 25 patients undergoing DIEP flap surgery with the use of Duramesh (MSI, Chicago, Ill.) by the senior author were identified. A retrospective chart review of patient and surgical details was performed. Charts were reviewed for outcomes, including surgical site infections, surgical site events, incisional hernia formation, and/or bulge. Standard descriptive summary statistics were used for patient characteristics, surgical details, and primary and secondary outcomes.

Results: Twenty-five patients were reviewed. Average follow-up duration was 216 ± 39 days. One patient (4%) developed a surgical site infection, and four patients (16%) developed a surgical site event. One patient developed a bulge, but no patients developed an incisional hernia.

Conclusions: Duramesh mesh suture provides a promising opportunity for DIEP surgeons to minimize both abdominal wall morbidity and mesh-related complications. Mesh suture can be used in a similar fashion as other sutures to perform primary closure of the anterior rectus sheath while also providing force-distribution benefits typically unique to planar mesh. This pilot study suggests that Duramesh is a safe, simple alternative to existing techniques in DIEP flap surgery and can be considered by microsurgeons to reduce fascial dehiscence, bulge, and/or hernia formation.

Fig. 1.

Duramesh mesh suture device (item MSI-301 pictured). Image courtesy of Mesh Suture Inc. Used with permission.

Fig. 2.

Use of Duramesh mesh suture to close anterior rectus sheath after unilateral left-sided DIEP flap harvest. A, Left lateral view of patient’s preoperative abdominal contour. B, Defect in anterior rectus sheath after DIEP flap harvest. C, Completed Duramesh mesh sutured closure of anterior rectus sheath defect. D, Left lateral view of patient’s postoperative abdominal contour.