Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2024; 57(01): 039-046
DOI: 10.1055/s-0043-1777076
Original Article

DIEP Flap for Head and Neck Reconstruction: An Underutilized Option!

Dushyant Jaiswal 
1   Plastic and Reconstructive Surgery, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
,
Firoz Borle
2   Siddharth Gupta Memorial cancer Hospital, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Maharashtra, India
,
Saumya Mathews 
1   Plastic and Reconstructive Surgery, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
,
Mayur Mantri 
1   Plastic and Reconstructive Surgery, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
,
Vineet Kumar
1   Plastic and Reconstructive Surgery, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
,
Ameya Bindu 
1   Plastic and Reconstructive Surgery, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
,
Prabha Yadav
3   Plastic and Reconstructive Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Maharashtra, India
4   Department of Plastic and Reconstructive surgery, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
,
Vinay Kant Shankhdhar 
1   Plastic and Reconstructive Surgery, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background The deep inferior epigastric artery perforator (DIEP) flap is a workhorse flap for breast reconstruction. Its use for head and neck (HN) reconstruction is rare. Abdomen provides a donor site abundant in skin and subcutaneous tissue, amenable to primary closure; sizeable, robust, and consistent perforators and a long, sizeable pedicle for comfortable microvascular anastomosis. Its offers all the donor variables needed for HN reconstruction in abundance.

Methods It is a quasiexperimental design study. DIEP flap use for HN reconstruction in our series was opportunistic, that is, when donor site matched the defect. Cases that had very thick thighs and lesser bulk in abdomen and cases that had very thin thighs but much more bulk in abdomen were considered for reconstruction using DIEP flap.

Results The DIEP flap was done in 11 cases for HN reconstruction. There were two re-explorations during postoperative period: one flap loss and another had partial necrosis.

Conclusion Abdomen is an excellent donor site option for HN reconstruction in selected cases, especially when harvested as a perforator flap.

Keywords

DIEP flap - HN reconstruction - large defects - musculocutaneous rectus abdominis flaps


Publication History

Article published online:
28 November 2023

© 2023. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Cordeiro PG. Breast reconstruction after surgery for breast cancer. N Engl J Med 2008; 359 (15) 1590-1601
    CrossrefPubMedGoogle Scholar
  • 2 Healy C, Allen Sr RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg 2014; 30 (02) 121-125
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 McLeod GJ, Islur A. Donor site scar preference in patients requiring free flap reconstruction. Plast Surg (Oakv) 2020; 28 (02) 88-93
    CrossrefPubMedGoogle Scholar
  • 4 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (06) 645-648
    CrossrefPubMedGoogle Scholar
  • 5 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 6 Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 1999; 52 (02) 104-111
    CrossrefPubMedGoogle Scholar
  • 7 Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat 2008; 21 (02) 89-98
    CrossrefPubMedGoogle Scholar
  • 8 Weiler-Mithoff E, Hodgson ELB, Malata CM. Perforator flap breast reconstruction. Breast Dis 2002; 16: 93-106
    CrossrefPubMedGoogle Scholar
  • 9 Koshima I, Moriguchi T, Soeda S, Tanaka H, Umeda N. Free thin paraumbilical perforator-based flaps. Ann Plast Surg 1992; 29 (01) 12-17
    CrossrefPubMedGoogle Scholar
  • 10 Borse V, Konwar AN, Buragohain P. Oral cancer diagnosis and perspectives in India. Sens Int 2020; 1: 100046
    CrossrefPubMedGoogle Scholar
  • 11 De la Parra-Marquez M, Fernandez-Riera R, Romay-Chambers E, Escamilla Linaje T. Superficial thinning of the DIEP flap: a safe option to achieve an aesthetic reconstructed breast in the obese patient. Plast Reconstr Surg 2021; 148 (05) 715e-719e
    CrossrefPubMedGoogle Scholar
  • 12 Colakoglu S, Tebockhorst S, Freedman J. et al. CT angiography prior to DIEP flap breast reconstruction: a randomized controlled trial. J Plast Reconstr Aesthet Surg 2022; 75 (01) 45-51
    CrossrefPubMedGoogle Scholar