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Complications of free bipedicled DIEP flaps in breast reconstruction: a systematic review and meta-analysis

  • Review
  • Published:
European Journal of Plastic Surgery Aims and scope

Abstract

Background

In breast reconstruction, augmenting the blood supply to the abdominal flap decreases the risk of adverse effects. This technique is utilized in patients with risk factors such as smoking, obesity, and a history of chest wall irradiation. A surgeon may opt to use procedures such as free bipedicled flaps, vascular delay, or conventional bipedicled transverse rectus abdominus myocutaneous flaps. The free bipedicled deep inferior epigastric perforator (DIEP) flap is the best option; however, information on the reliability of bipedicled DIEP compared to that of unipedicled flaps is lacking. We aimed to determine if there was a significant difference in complication rates between bipedicled and unipedicled DIEP flaps.

Methods

Electronic search in PubMed, Cochrane Library, Ovid, and Scopus databases was performed. After screening, data were extracted based on the donor site, recipient site, and adverse effects. Descriptive statistics were generated for all pooled data. A meta-analysis was performed to determine the relative risk (RR) ratios with 95% confidence intervals (CIs) using a random-effects model.

Results

Our search yielded 19 unrelated studies of 920 bipedicled DIEP flaps that met the inclusion criteria and were included. The meta-analysis conducted on five papers showed that the risk of fat necrosis was significantly higher in unipedicled flaps than in bipedicled flaps (RR 0.30 [95% CI 0.19–0.48]; P < 0.00001). There was no significant difference in the risk of other complications between the two flaps. However, descriptive analysis appeared to favor bipedicled DIEP flap reconstruction.

Conclusions

Bipedicled DIEP flap reconstruction is safe and reliable, especially in patients with midline abdominal scars, insufficient abdominal fat, and contralateral large breasts.

Level of Evidence: Not gradable. 

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Correspondence to Nada Raafat Khattab.

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Nada Raafat Khattab declares no competing interests.

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Khattab, N.R. Complications of free bipedicled DIEP flaps in breast reconstruction: a systematic review and meta-analysis. Eur J Plast Surg 45, 39–53 (2022). https://doi.org/10.1007/s00238-021-01862-w

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  • DOI: https://doi.org/10.1007/s00238-021-01862-w

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