title: Perfusion-related complications are similar for DIEP and muscle-sparing free TRAM flaps harvested on medial or lateral deep inferior epigastric Artery branch perforators for breast reconstruction.
abstract: BACKGROUND
  Anatomical studies suggest that the deep inferior epigastric artery (DIEA) medial branch perfuses more tissue across the midline than the lateral branch. The authors hypothesized that unilateral deep inferior epigastric perforator (DIEP) and muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flaps based on medial branch perforators would have fewer perfusion-related complications.
  
  
  METHODS
  The authors evaluated consecutive DIEP or muscle-sparing TRAM free flaps definitively harvested from a single DIEA branch. Flaps were grouped by tissue volume (hemiflaps, cross-midline flaps, or total flaps). Primary outcome measures were fat necrosis and partial flap necrosis. Logistic regression was used to evaluate the association between patient and reconstruction characteristics and outcomes.
  
  
  RESULTS
  There were 228 patients, with 120 medial (52.6 percent) and 108 lateral (47.4 percent) branch flaps. Mean follow-up was 33.2 months. Cross-midline flaps (79.8 percent) were the most common design. Medial and lateral branch flaps had similar rates of fat necrosis (8.3 percent and 13.0 percent, respectively; p = 0.26) and partial flap necrosis (3.3 percent and 2.8 percent, respectively; p = 1.0). There was no difference in the incidence of fat necrosis between DIEP and muscle-sparing free TRAM flaps (10.2 percent and 11.3 percent, respectively; p = 0.81) or in partial necrosis (3.2 percent and 2.8 percent, respectively; p = 1.0). Medial and lateral branch flap perfusion-related complications were also similar among the flap volume classifications.
  
  
  CONCLUSIONS
  The authors suggest that surgeons base their decisions regarding DIEA branch harvest on the clinical assessment of perforator perfusion quality rather than relying on the theoretical benefit of medial branch perforator harvest.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Houston, Texas From the Departments of Plastic Surgery and Biostatistics, University of Texas M. D. Anderson Cancer Center.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Garvey
authors.forename: Seroos
authors.initials: S
authors.lastname: Salavati
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
mesh_terms: D000328:Adult; D019074:Epigastric Arteries / Q000601:surgery*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply* / Q000473:pathology; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome
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