title: Bipedicled DIEAP flaps for reconstruction of limb soft tissue defects in male patients.
abstract: BACKGROUND
  Extensive soft tissue deficiencies involving the limbs can be difficult to reconstruct and may require more than one microsurgical flap transfer to cover the defect. This can be particularly challenging in male patients, where the sacrifice of a donor muscle could result in considerable comorbidity. This paper describes the use of the bipedicled deep inferior epigastric artery perforator (DIEAP) flap to perform a one-stage reconstruction of extensive soft tissue defects in male patients.
  
  
  METHODS
  By using preoperative multidetector computed tomographic (MDCT) angiography, the dominant perforators of the abdominal wall were identified and the bipedicled DIEAP flap was used for a one-stage reconstruction of complicated tissue loss in 12 male patients. In seven of these flaps, a microsurgical anastomosis between the two epigastric pedicles of the DIEAP flap was carried out. The feasibility of the procedure, clinical outcome, and possible associated comorbidities were evaluated.
  
  
  RESULTS
  Successful large tissue reconstructions were performed using all four traditional zones of the DIEAP flap, with dimensions of flaps ranging from 20 × 8 to 50 × 17 cm. Venous congestion was seen to develop in two flaps, one of which was salvaged by performing an additional venous anastomosis, but the other flap failed to survive. Apart from this, complications were minimal.
  
  
  CONCLUSIONS
  Soft tissue coverage of extensive wounds in male patients without sacrificing muscle flaps can be challenging. This extended utilization of the entire DIEAP flap has helped us to address this issue.
authors.affiliation: University Hospital, Gent, Belgium; Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: Ajay L
authors.initials: AL
authors.lastname: Mahajan
authors.affiliation: Department of Plastic & Reconstructive Surgery, University Hospital, Gent, Belgium.
authors.forename: Carl
authors.initials: C
authors.lastname: Van Waes
authors.affiliation: Department of Plastic & Reconstructive Surgery, University Hospital, Gent, Belgium.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Arpa
authors.affiliation: Department of Plastic & Reconstructive Surgery, University Hospital, Gent, Belgium.
authors.forename: Koenraad
authors.initials: K
authors.lastname: Van Landuyt
authors.affiliation: Department of Plastic & Reconstructive Surgery, University Hospital, Gent, Belgium.
authors.forename: Phillip N
authors.initials: PN
authors.lastname: Blondeel
authors.affiliation: Department of Plastic & Reconstructive Surgery, University Hospital, Gent, Belgium.
authors.forename: Stan
authors.initials: S
authors.lastname: Monstrey
authors.affiliation: Department of Plastic & Reconstructive Surgery, University Hospital, Gent, Belgium. Electronic address: filip.stillaert@ugent.be.
authors.forename: Filip B
authors.initials: FB
authors.lastname: Stillaert
mesh_terms: D034861:Abdominal Wall / Q000098:blood supply / Q000601:surgery; D000328:Adult; D001134:Arm Injuries / Q000150:complications*; D019074:Epigastric Arteries / Q000601:surgery*; D005542:Forearm / Q000098:blood supply / Q000601:surgery; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000601:surgery; D007869:Leg Injuries / Q000150:complications*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000209:etiology / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Bipedicled DIEAP flap; Extremity trauma; Male patients; Microsurgery