Midline epigastric scars can be associated with higher umbilical complications following DIEP flap harvest

Jerry H. Yang, Salih Colakoglu, Marc A.M. Mureau, Duygu Siddikoglu, Ariel C. Johnson, Justin B. Cohen, Bernard T. Lee, Tae W. Chong, David W. Mathes, Christodoulos Kaoutzanis*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Umbilical complications can be relatively common after breast reconstruction with deep inferior epigastric perforator (DIEP) flaps. The medial umbilical ligaments and the ligamentum teres hepatis can be the sole blood supply to the umbilicus after a DIEP flap harvest. Prior incisions along the epigastric midline may disrupt the ligamentum teres hepatis. In this retrospective study, we assess the influence of previous midline epigastric scars on umbilical complications after DIEP flap harvest. Methods: All patients who underwent breast reconstruction with DIEP flaps were identified at an academic institution over six years. Relevant sociodemographic and clinicopathologic factors were reviewed in the electronic medical records. Univariate and multivariate analyses were performed to determine the role of clinical variables to predict the chance of umbilical complications. Results: A total of 243 patients met inclusion criteria, with 39 patients (16%) having prior surgery utilizing midline epigastric incisions. Twenty-one patients had umbilical complications. No significant difference in patient characteristics was found between patients with and without prior midline epigastric scars. Patients with a history of previous midline epigastric scars had a higher rate of umbilical complications (20.5% vs. 6.4%, p < 0.01). Bilateral medial row perforator-based DIEP flap harvest was also related to a higher rate of umbilical complications (18.4% vs. 6.2% p < 0.01). Conclusion: Previous midline epigastric scars are associated with higher rates of umbilical complications after DIEP flap harvest. Bilateral medial row perforator-based DIEP flap harvest exacerbates the rate of umbilical complications and should be avoided in patients with prior midline epigastric incision whenever possible.

Original languageEnglish
Pages (from-to)1826-1832
Number of pages7
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume75
Issue number6
DOIs
Publication statusAccepted/In press - 21 Jan 2022

Bibliographical note

Funding Information:
The authors have no financial interests in this research project or in any of the techniques or equipment used in this study. Approval has been obtained by the Institutional Review Board at University of Colorado Hospital (Reference number: 19?1564).

Publisher Copyright:
© 2022 Elsevier Ltd

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