Volume change in the rectus abdominis muscle after deep inferior epigastric perforator flap harvest

Publication date: Available online 25 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hyun Ho Han, Min Kyu Kang, Sin Young Song, Hyung Chul Lee, Eun Key Kim, Jin Sup Eom
Deep inferior epigastric perforator flap has less donor site morbidity than that of transverse rectus abdominis myocutaneous flap. However, abdominal muscle atrophy and donor site complications caused by denervation during pedicle dissection cannot be avoided. This retrospective study investigated the change in rectus abdominis muscle volume after deep inferior epigastric perforator flap harvest. Of 395 patients who underwent unilateral deep inferior epigastric perforator flap breast reconstruction between August 2007 and July 2017, 25 patients with >2-year postoperative abdominal computed tomography data were evaluated. Preoperative and postoperative images of the abdominal muscle after pedicle dissection and of the nonoperated side were compared. The volume of the muscles from the lower margin to the umbilicus was determined by using OsiriX image analysis. The volume on the side of pedicle dissection decreased from 72.63 ± 23.29 cm³ preoperatively to 53.09 ± 16.93 cm³ postoperatively(p < 0.001). The corresponding volumes on the side without dissection were 73.29 ± 19.25 cm³ and 60.89 ± 18.79 cm³ (p < 0.001). The percentage of postoperatively retained volume relative to the preoperative volume was 75.65% ± 19.18% on the pedicle dissection side and 84.65% ± 19.00% on the contralateral side. The 9% difference was not statistically significant (p = 0.10). No major abdominal complications were observed. Despite nerve injury during deep inferior epigastric perforator flap surgery, the volume loss of the involved and contralateral muscle did not differ. More than 75% of the abdominal muscle volume was retained. Muscle integrity was well maintained without any postoperative complications.