Evaluation of clinical outcomes of deep inferior epigastric artery perforator flap breast reconstruction and number of flap perforators

BackgroundPerforator flaps have revolutionized reconstructive surgery over the past decades specifically breast reconstruction. Deep inferior epigastric perforator (DIEP) flap is considered the workhorse perforator free flap for breast reconstruction worldwide. There has always been a debate regarding the adequate number of harvested perforators to minimize flap and donor-site complications. The aim of this study was to evaluate the effect of number of perforators harvested on the overall DIEP flap survival and flap-related complications in addition to donor-site complications.Patients and methodsA prospective review was performed on all DIEP flaps performed over 18 months. The flaps were subdivided based on the number of perforators used in each flap and outcomes evaluated regarding flap survival, flap-related complications, and donor-site complications. ResultsA total of 63 patients underwent 72 DIEP flaps. No significant differences were noted in the flap complication rate or the abdominal complications across perforator groups. However, the subgroup analysis showed slight increased rates of fat necrosis among single and double perforators when compared with triple perforators, but it did not reach statistical significance.ConclusionsThe number of DIEP flap perforators does not significantly affect the flap loss rates or abdominal complications rates. However, the rate of fat necrosis may be higher in single-perforator DIEP flaps, suggesting that multiple perforators when feasible to be done with minimal muscle damage may lead to better flap perfusion.