title: Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction without Microsurgery Fellowship Training.
abstract: BACKGROUND
  Deep inferior epigastric artery perforator (DIEP) flap breast reconstruction requires complex microsurgical skills. Herein, we examine whether DIEP flap breast reconstruction can be performed safely without microsurgical fellowship training.
  
  
  METHODS
  A total of 28 patients and 34 DIEP flaps were included in the study. We reviewed the medical records of patients for donor site and flap-related complications and analyzed the correlation between the complications and preoperative risk factors. We also performed a literature review to compare complication rates in our series with the literature.
  
  
  RESULTS
  We observed total flap necrosis in 1 patient (2.9%), partial flap necrosis in 5 patients (14.7%), infection in 1 patient (2.9%), hematoma/seroma in 3 patients (8.8%), donor site complications in 5 patients (18.5%), venous occlusion in 4 patients (11.7%), and arterial occlusion in 1 patient (2.9%). We did not observe any correlation between complications and preoperative risk factors. Literature review yielded 18 papers that met our inclusion criteria. Partial flap necrosis rate was significantly higher in our series compared with literature (14.7% vs 1.6%, P = 0.003). Venous complication rate was marginally higher in our series compared with literature (11.7% vs 3.3%, P = 0.057). However, total flap loss rate in our series was comparable with the literature (2.9% vs 2.2%, P = 0.759).
  
  
  CONCLUSIONS
  With proper training during plastic surgery residency, DIEP flap can be performed with acceptable morbidity.
authors: University of California Davis Medical Center, Department of Surgery, Division of Plastic Surgery, Sacramento, Calif.; and University of Texas San Antonio Medical Center, Department of Surgery, Division of Plastic Surgery, San Antonio, Tex.
authors: Hakan
authors: H
authors: Orbay
authors: University of California Davis Medical Center, Department of Surgery, Division of Plastic Surgery, Sacramento, Calif.; and University of Texas San Antonio Medical Center, Department of Surgery, Division of Plastic Surgery, San Antonio, Tex.
authors: Brittany K
authors: BK
authors: Busse
authors: University of California Davis Medical Center, Department of Surgery, Division of Plastic Surgery, Sacramento, Calif.; and University of Texas San Antonio Medical Center, Department of Surgery, Division of Plastic Surgery, San Antonio, Tex.
authors: Thomas R
authors: TR
authors: Stevenson
authors: University of California Davis Medical Center, Department of Surgery, Division of Plastic Surgery, Sacramento, Calif.; and University of Texas San Antonio Medical Center, Department of Surgery, Division of Plastic Surgery, San Antonio, Tex.
authors: Howard T
authors: HT
authors: Wang
authors: University of California Davis Medical Center, Department of Surgery, Division of Plastic Surgery, Sacramento, Calif.; and University of Texas San Antonio Medical Center, Department of Surgery, Division of Plastic Surgery, San Antonio, Tex.
authors: David E
authors: DE
authors: Sahar