OasisLMS

This series of four videos details the process of DIEP Flap Breast Reconstruction.

Segment 1 - Dissection of the recipient site and vessels

Preparation of the chest for flap placement and preparation of the recipient vessels

Segment 2 - Abdominal Flap Harvest 

Dissection of the flap and perforators from the abdomen

Segment 3 - Microsurgical anastomosis

Anastomoses of deep inferior epigastric vessels to the internal mammary vessels

Segment 4 - Flap inset and closure of abdomen

Formation of the breast mound with the free flap, closure of abdominal wall donor site 

Learning Objectives

After reviewing these videos, the learner should be able to

1. Describe how to systematically dissect and prepare the chest recipient site, including exposure and preparation of the internal mammary vessels, while optimizing flap positioning, minimizing morbidity, and preserving options for future reconstruction.
2. Explain how to safely design and elevate a DIEP flap, identify and dissect dominant perforators, and preserve abdominal wall integrity by minimizing muscle sacrifice and preventing donor-site complications.
3. Summarize how to perform precise end-to-end microsurgical anastomoses between the deep inferior epigastric vessels and the internal mammary vessels, including troubleshooting flow-related issues and managing intraoperative complications 
4. Describe how to shape and inset the DIEP flap to create an aesthetically pleasing and durable breast mound, and execute tension-free closure of the abdominal wall donor site with strategies to reduce contour deformity, hernia, and wound-healing complications.

Intended Audience

This educational activity is intended for plastic surgery practitioners, residents, and other healthcare professionals.

Surgeon: Maurice Nahabedian, MD, FACS
Annotations: John Oeltjen, MD, PhD

• Patient Care & Procedural Skills 
• Medical Knowledge
• Practice-Based Learning and Improvement