A critical review of perioperative complications in 175 free deep inferior epigastric perforator flap breast reconstructions.
BACKGROUND
The purpose of this study was to critically evaluate the perioperative complications for deep inferior epigastric perforator (DIEP) flap breast reconstruction.


METHODS
From February 2002 until February 2006, 175 consecutive abdominal free tissue breast reconstructions were performed in 131 patients. Perioperative risk factors and complications were evaluated for the entire group. Data analysis was performed to compare subsequent chronologic groups for a learning curve effect.


RESULTS
In 159 cases (90.9%) a DIEP flap could be raised. In 13 cases (7.4%), a mini-TRAM flap and in 3 cases (1.7%) a regular free TRAM flap was harvested. A learning curve was found showing a risk for flap complications in the first 30 DIEP flaps of 40% and in flaps 31 to 175 of 13.8% (P < 0.012). Microsurgical revision rate was 4% (n = 7), with a total flap failure rate of 0.6% (n = 1). Partial flap failure rate was 8.6% (n = 15), which was solved by debridement, medial advancement, and direct closure in 6.8% (n = 12) and latissimus dorsi flap transposition in 1.8% (n = 3). Multivariate analysis showed no significant influence of risk factors on development of postoperative flap complications.


CONCLUSIONS
DIEP flap breast reconstruction is an excellent method, with limited donor-site morbidity. A definite learning curve was reflected in a larger number of flap complications in the beginning of our series.
Department of Plastic and Reconstructive Surgery, Erasmus Medical Center Rotterdam, NL-3000 CA Rotterdam, The Netherlands. s.hofer@erasmusmc.nl
Stefan O P
SO
Hofer
Tim H C
TH
Damen
Marc A M
MA
Mureau
Hinne A
HA
Rakhorst
Nathalie A
NA
Roche
D000328:Adult; D000368:Aged; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D016462:Mammaplasty / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D013524:Surgical Flaps / Q000009:adverse effects*