Pedicle stabilization with fibrin sealant in DIEP flap breast reconstruction

Microsurgical procedures are nowadays routinely performed worldwide in reconstructive surgery. The deep inferior epigastric artery perforator (DIEP) flap has become the gold standard in breast reconstruction due to its excellent outcomes and lower donor site morbidity. However, complications, including flap failure, still occur in DIEP flap breast reconstruction. Often, according to our experience, these complications result from pedicle disorders, which can be attributed to postoperative mobilization. In the present study, we evaluated the efficacy and safety of using a fibrin sealant as a method for pedicle stabilization to prevent pedicle mobilization in the postoperative period. With our technique, after the flap insetting and microsurgical anastomosis, the pedicle was stabilized by applying a fibrin sealant (TISSEEL (TM)) around and over the entire pedicle. Our study included a homogeneous series of 70 patients who received a delayed DIEP flap breast reconstruction. A retrospective study was conducted to evaluate this novel technique compared to the conventional method. In our experience, the fibrin glue allowed us to reduce the strain for correct pedicle positioning and all subsequent efforts to avoid displacements in the postoperative period. Our preliminary results suggest that this method may lead to a reduction in overall complications attributable to pedicle disorders.