title: Deep inferior epigastric artery perforator flap donor-site closure with cannula-assisted, limited undermining, and progressive high-tension sutures versus standard abdominoplasty: complications, sensitivity, and cosmetic outcomes.
abstract: BACKGROUND
  In deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, abdominal donor-site cosmetic and sensibility outcomes and the closure technique have drawn little attention in the literature, with many surgeons still following the principles of standard abdominoplasty. In this article, the authors report their experience with the cannula-assisted, limited undermining, and progressive high-tension suture ("CALP") technique of DIEP donor-site closure compared with standard abdominoplasty.
  
  
  METHODS
  Between December of 2008 and January of 2013, 137 consecutive women underwent DIEP flap breast reconstruction. Of these, 82 patients (between December of 2008 and November of 2011) underwent DIEP flap donor-site closure by means of standard abdominoplasty (control group) and 55 patients (from December of 2011 to January of 2013) by means of cannula-assisted, limited undermining, and progressive high-tension suture (study group). The abdominal drainage daily output, donor-site complications, abdominal skin sensitivity at 1-year follow-up, cosmetic outcomes, and patient satisfaction were recorded and analyzed statistically.
  
  
  RESULTS
  Daily drainage output was significantly lower in the study group. Donor-site complications were significantly higher in the control group (37.8 percent versus 9 percent). Seroma and wound healing problems were experienced in the control group. Abdominal skin sensibility was better preserved in the study group. Overall, abdominal wall aesthetic outcomes were similar in both groups, except for scar quality (better in the study group).
  
  
  CONCLUSIONS
  According to the authors' experience, cannula-assisted, limited undermining, and progressive high-tension suture should be always preferred to standard abdominoplasty for DIEP donor-site closure to reduce the complication rate to improve abdominal skin sensitivity and scar quality.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Rome and Salerno, Italy From the Department of Plastic and Reconstructive Surgery, Università Cattolica del "Sacro Cuore," University Hospital "A. Gemelli"; and the Department of Economics and Statistics, Università di Salerno.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Visconti
authors.forename: Federica
authors.initials: F
authors.lastname: Tomaselli
authors.forename: Anna
authors.initials: A
authors.lastname: Monda
authors.forename: Liliana
authors.initials: L
authors.lastname: Barone-Adesi
authors.forename: Marzia
authors.initials: M
authors.lastname: Salgarello
mesh_terms: D061645:Abdominoplasty / Q000009:adverse effects; D000328:Adult; D000368:Aged; D019074:Epigastric Arteries; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D013536:Suture Techniques / Q000009:adverse effects; D013537:Sutures; D060053:Transplant Donor Site / Q000601:surgery*; D016896:Treatment Outcome