title: Are Pfannenstiel scars a boon or a curse for DIEP flap breast reconstructions?
abstract: BACKGROUND
  Abdominal incisions and their subsequent scarring alter the vascular architecture of the abdominal pannus. This is of significance when reconstructing the breast with the deep inferior epigastric perforator (DIEP) flap. This study aimed to objectively investigate the impact of the lower abdominal Pfannenstiel scar in utilizing the DIEP flap.
  
  
  METHODS
  A retrospective study of breast reconstruction with DIEP flaps was conducted on patients who had a Pfannenstiel scar (n = 36) compared with patients who did not (n = 36). Computed tomography angiograms were analyzed for the numbers, positions, and dimensions of perforator vessels. Influence of the scar on the reconstructive outcome was assessed.
  
  
  RESULTS
  The number of perforators was greater in the control group (mean, 9.14) compared with the study group (mean, 8.3) but was not significant, with marginal significance (p = 0.09). The percentage of found perforators with 4 mm or greater was significantly higher in the study group than in the control group (21.7 percent compared with 14.3 percent, respectively; p = 0.04). The position of perforators was more or less the same, and complications were also comparable in both groups.
  
  
  CONCLUSIONS
  Pfannenstiel incisions result in undermining of the lower abdominal apron and, in most cases, division of the superficial epigastric vessels. This results in "ischemic preconditioning" of the flap, as has been evidenced by the increased dimensions of the perforators. Hence, flaps raised from these abdomens are not only safe but may even be better vascularized.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Brussels and Ghent, Belgium From the Department of Plastic and Reconstructive Surgery, University Hospital, Brussels; and Ghent University Hospital.
authors.forename: Ajay L
authors.initials: AL
authors.lastname: Mahajan
authors.forename: Assaf
authors.initials: A
authors.lastname: Zeltzer
authors.forename: Karel E Y
authors.initials: KEY
authors.lastname: Claes
authors.forename: Koenraad
authors.initials: K
authors.lastname: Van Landuyt
authors.forename: Moustapha
authors.initials: M
authors.lastname: Hamdi
mesh_terms: D002921:Cicatrix / Q000209:etiology*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply*