title: Comparison of abdominal wall morbidity between medial and lateral row-based deep inferior epigastric perforator flap.
abstract: BACKGROUND
  Although deep inferior epigastric perforator (DIEP) flap is associated with decreased abdominal morbidity, motor nerve damage during flap elevation cannot be ignored. We compared abdominal morbidity after elevation of DIEP flap with lateral row perforators (L-DIEP) and medial row perforators (M-DIEP) to determine the perforators associated with less abdominal morbidity.
  
  
  METHODS
  Women who underwent breast reconstruction with DIEP flaps (n = 49) were included in this study. Among them, M-DIEP and L-DIEP were harvested in 27 and 22 patients, respectively. Pre- and postoperative trunk flexor muscle ability (at 3 and 6 months after surgery) was measured prospectively in all patients using an isokinetic dynamometer. The patients were also investigated for postoperative pain, stiffness, activity, bulging, and lumbago.
  
  
  RESULTS
  At 3 months after surgery, a significant decrease in trunk flexor muscle ability was observed in the patients of the L-DIEP group, but they recovered well after further 3 months. However, the recovery tended to be weak. Similar results were obtained with respect to pain, stiffness, activity, bulging, and lumbago between the two groups at 6 months after surgery.
  
  
  CONCLUSIONS
  Dominant perforators for DIEP flap elevation should be chosen by considering flap viability. However, surgeons should be aware that elevation with L-DIEP is associated with a high risk of nerve injury, and may in turn result in short-term decreases in trunk flexor muscle ability. Therefore, precautionary methods should be taken by the surgeons to preserve the motor nerve with atraumatic dissection, especially during elevation with L-DIEP.
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan. Electronic address: udaarare@jichi.ac.jp.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Uda
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Yoko Katsuragi
authors.initials: YK
authors.lastname: Tomioka
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Syunji
authors.initials: S
authors.lastname: Sarukawa
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Ataru
authors.initials: A
authors.lastname: Sunaga
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Yasusih
authors.initials: Y
authors.lastname: Sugawara
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D019074:Epigastric Arteries / Q000637:transplantation*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D019520:Living Donors; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D061525:Perforator Flap / Q000098:blood supply*; D011183:Postoperative Complications / Q000453:epidemiology*; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000379:methods
keywords: Abdominal morbidity; Deep inferior epigastric perforator flap; Flexor trunk muscle ability; Isokinetic dynamometer; Lateral row perforator; Medial row perforator