Evidence-based Algorithms for Free Deep Inferior Epigastric Perforator Flap Salvage in Autologous Breast Reconstruction
Background:. Breast reconstruction with the deep inferior epigastric perforator (DIEP) free flap has become the gold standard for autologous breast reconstruction. Flap take-back to the operating room (OR) is an uncommon but difficult situation, requiring prompt and accessible resources. We conducte...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-01-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006477 |
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| author | Anna R. Todd, MD, PhD, FRCSC Mawaddah Alrajraji, MD Kathryn Sawa, MD Joan E. Lipa, MD, MSc Laura Snell, MD, MSc |
| author_facet | Anna R. Todd, MD, PhD, FRCSC Mawaddah Alrajraji, MD Kathryn Sawa, MD Joan E. Lipa, MD, MSc Laura Snell, MD, MSc |
| author_sort | Anna R. Todd, MD, PhD, FRCSC |
| collection | DOAJ |
| description | Background:. Breast reconstruction with the deep inferior epigastric perforator (DIEP) free flap has become the gold standard for autologous breast reconstruction. Flap take-back to the operating room (OR) is an uncommon but difficult situation, requiring prompt and accessible resources. We conducted a literature review and independent expert review to inform evidence-based perioperative algorithms in the event of DIEP flap compromise.
Methods:. A review of the literature was conducted, including MEDLINE, Embase, Google Scholar, and Cochrane Controlled Register of Trials. Publications examining free flap re-exploration in breast reconstruction were used to inform evidence-based clinical algorithms. The algorithms then underwent expert review and revisions from 6 international experts in microsurgery.
Results:. Three evidence-based management algorithms were created. The first algorithm outlines perioperative management strategies to optimize patient care and prompt return to the OR. Nonconstricting flap inset after take-back, salvage medical strategies and postoperative management following flap failure were additionally included. Algorithms 2 (venous congestion) and 3 (vascular thrombosis) provide specific intraoperative strategies surrounding mechanical decompression, pedicle exposure, assessment and extraction of thrombosis, identification and use of alternative recipient vessels, and the usage of intraoperative thrombolytics.
Conclusions:. A coherent and stepwise approach to DIEP flap compromise in breast reconstruction was developed. These expert-reviewed algorithms provide an approachable and evidence-based structure to support return to the OR and serve as readily available resources. |
| format | Article |
| id | doaj-art-ef212b95a08d4061a55ea8d5c2527e5f |
| institution | Kabale University |
| issn | 2169-7574 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj-art-ef212b95a08d4061a55ea8d5c2527e5f2025-01-24T09:19:58ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742025-01-01131e647710.1097/GOX.0000000000006477202501000-00046Evidence-based Algorithms for Free Deep Inferior Epigastric Perforator Flap Salvage in Autologous Breast ReconstructionAnna R. Todd, MD, PhD, FRCSC0Mawaddah Alrajraji, MD1Kathryn Sawa, MD2Joan E. Lipa, MD, MSc3Laura Snell, MD, MSc4From the * Section of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada† Division of Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Toronto, ON, Canada‡ Division of Surgery, McMaster University, Cambridge Memorial Hospital, Cambridge, ON, Canada.† Division of Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Toronto, ON, Canada† Division of Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Toronto, ON, CanadaBackground:. Breast reconstruction with the deep inferior epigastric perforator (DIEP) free flap has become the gold standard for autologous breast reconstruction. Flap take-back to the operating room (OR) is an uncommon but difficult situation, requiring prompt and accessible resources. We conducted a literature review and independent expert review to inform evidence-based perioperative algorithms in the event of DIEP flap compromise. Methods:. A review of the literature was conducted, including MEDLINE, Embase, Google Scholar, and Cochrane Controlled Register of Trials. Publications examining free flap re-exploration in breast reconstruction were used to inform evidence-based clinical algorithms. The algorithms then underwent expert review and revisions from 6 international experts in microsurgery. Results:. Three evidence-based management algorithms were created. The first algorithm outlines perioperative management strategies to optimize patient care and prompt return to the OR. Nonconstricting flap inset after take-back, salvage medical strategies and postoperative management following flap failure were additionally included. Algorithms 2 (venous congestion) and 3 (vascular thrombosis) provide specific intraoperative strategies surrounding mechanical decompression, pedicle exposure, assessment and extraction of thrombosis, identification and use of alternative recipient vessels, and the usage of intraoperative thrombolytics. Conclusions:. A coherent and stepwise approach to DIEP flap compromise in breast reconstruction was developed. These expert-reviewed algorithms provide an approachable and evidence-based structure to support return to the OR and serve as readily available resources.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006477 |
| spellingShingle | Anna R. Todd, MD, PhD, FRCSC Mawaddah Alrajraji, MD Kathryn Sawa, MD Joan E. Lipa, MD, MSc Laura Snell, MD, MSc Evidence-based Algorithms for Free Deep Inferior Epigastric Perforator Flap Salvage in Autologous Breast Reconstruction Plastic and Reconstructive Surgery, Global Open |
| title | Evidence-based Algorithms for Free Deep Inferior Epigastric Perforator Flap Salvage in Autologous Breast Reconstruction |
| title_full | Evidence-based Algorithms for Free Deep Inferior Epigastric Perforator Flap Salvage in Autologous Breast Reconstruction |
| title_fullStr | Evidence-based Algorithms for Free Deep Inferior Epigastric Perforator Flap Salvage in Autologous Breast Reconstruction |
| title_full_unstemmed | Evidence-based Algorithms for Free Deep Inferior Epigastric Perforator Flap Salvage in Autologous Breast Reconstruction |
| title_short | Evidence-based Algorithms for Free Deep Inferior Epigastric Perforator Flap Salvage in Autologous Breast Reconstruction |
| title_sort | evidence based algorithms for free deep inferior epigastric perforator flap salvage in autologous breast reconstruction |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006477 |
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