title: Abdominal morbidity after single- versus double-pedicled deep inferior epigastric perforator flap use.
abstract: OBJECTIVE
  The reduced incidence of donor site morbidity after deep inferior epigastric perforator (DIEP) flap is because the rectus muscle and its fascia are preserved. However, no study has proved that trunk flexion recovers not by the compensatory effect of the contralateral rectus muscle but by reinnervation of the ipsilateral rectus muscle. We hypothesized that if sufficient reinnervation occurs, patients who undergo single-pedicled DIEP (S-DIEP) flap or double-pedicled DIEP (D-DIEP) flap breast reconstruction would have similar levels of preoperative trunk flexion. To determine this, we investigated perioperative changes in trunk flexor muscle ability quantitatively using an isokinetic dynamometer in patients who had received S-DIEP or D-DIEP.
  
  
  METHODS
  Patients who underwent breast reconstruction with S-DIEP (n = 37) and D-DIEP (n = 30) were included in this study. Pre- and postoperative trunk flexor muscle ability was measured prospectively by an isokinetic dynamometer in all patients. Postoperative abdominal pain and stiffness, patients' activity, and incidence of bulging were also investigated.
  
  
  RESULTS
  Six months after surgery, the trunk flexor muscle ability recovered and did not significantly decrease subsequently in either group. This finding was consistent with the result that patients' activities and the incidence of bulging were similar between the two groups.
  
  
  CONCLUSIONS
  Our results show that reinnervation of the rectus muscle can be confirmed at 6 months after DIEP flap elevation. Thus, we recommend D-DIEP flap without concern for abdominal wall weakness, especially in patients with multiple abdominal scars and who require breast tissue exceeding the amount of tissue that can be transferred with S-DIEP flap.
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, 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, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan.
authors.forename: Yoko Katsuragi
authors.initials: YK
authors.lastname: Tomioka
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan.
authors.forename: Syunji
authors.initials: S
authors.lastname: Sarukawa
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan.
authors.forename: Ataru
authors.initials: A
authors.lastname: Sunaga
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kamochi
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan.
authors.forename: Yasusih
authors.initials: Y
authors.lastname: Sugawara
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotuke, Tochigi, 329-0498, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yoshimura
mesh_terms: D000005:Abdomen / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*; D053581:Muscle Strength Dynamometer; D061525:Perforator Flap; D017568:Rectus Abdominis / Q000294:innervation / Q000637:transplantation*; D012189:Retrospective Studies; D013524:Surgical Flaps
keywords: Breast reconstruction; Isokinetic dynamometer; Single- versus double-pedicled deep inferior epigastric perforator flap; Trunk flexor muscle ability