DIEP Flap Breast Reconstruction | Surgery Spotlight-Abdominal Flap Harvest

Video Transcription

Video Summary

The video presents a detailed surgical procedure for a deep inferior epigastric perforator (DIEP) flap breast reconstruction, preferred for patients with mastectomy and radiation, avoiding implant complications and preserving muscle function. The surgeon outlines indications—such as patients with previous radiation—and contraindications like obesity or multiple health issues due to the lengthy operation (4-10 hours). The surgery begins with careful skin markings, adjusted with patient positioning, and uses the patient's abdominal skin and fat while sparing the rectus abdominis muscle to maintain strength and reduce donor site problems.<br /><br />The surgeon identifies key perforator vessels near the umbilicus using Doppler and visual assessment to select the best blood supply for the flap. Due to a midline scar, a hemi-flap is taken, splitting the abdominal tissue, and meticulous dissection around scar tissue, muscle fibers, and neurovascular bundles is performed to isolate and preserve critical vessels and nerves. The surgeon manages challenges like fibrous tendinous inscriptions obstructing vessel dissection and potential perforator spasm. The operation emphasizes caution to ensure flap viability, sufficient blood flow, nerve preservation, and facilitates microvascular anastomosis with suitable caliber vessels. The procedure concludes with a well-vascularized flap ready for microsurgery and breast reconstruction.

Keywords

DIEP flap

breast reconstruction

mastectomy

radiation therapy

perforator vessels

microvascular anastomosis

donor site morbidity

rectus abdominis muscle preservation