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Diagonal upper gracilis (DUG) flap for autologous breast reconstruction: a case series

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Abstract

Background

The diagonal upper gracilis myocutaneous (DUG) flap is an alternative for free autologous flap breast reconstruction. It has evolved from the transverse upper gracilis (TUG) flap by changing the orientation of the skin island, providing more bulk and easier donor site closure. This comes at the expense of a possibly more visible scar. This retrospective report aims to evaluate both clinical and patient-reported outcomes. We discuss the indications and technical details of this less common flap.

Methods

Fifteen consecutive DUG-flaps for breast reconstruction in 9 patients over a 2-year period were analysed. The skin paddle of the DUG-flaps was oriented in an oblique direction as opposed to traditional horizontal or vertical designs. Data were collected from the medical files. All patients completed the BREAST-Q questionnaire and a questionnaire about the donor site (upper thigh) and adjunctive procedures. Minimal follow-up was 20 months.

Results

In this series, there was no flap revision or flap failure. The sole complications were related to the donor site with delayed wound healing and seromas occurring in 4 patients. The mean BREAST-Q scores were 72 for quality of life and 85 for satisfaction, which is comparable to other types of free autologous flaps. Long-term discomfort during activities at the donor site scar was common. Scar visibility or the postoperative contour of the thighs was not a major concern. Adjunctive procedures further improved satisfaction with the final result.

Conclusions

The DUG flap is an improvement of the TUG flap, providing more tissue and easier donor site closure. This makes it a valuable option for breast reconstruction in women whose abdomen is not available as a donor site. In bilateral cases, it has the advantage over gluteal and lumbar flaps, that both breasts can be reconstructed in one procedure. Disadvantages include donor site problems and a high need for additional lipofilling procedures. Technical refinements of the procedure are being discussed.

Level of evidence: Level IV, Therapeutic study

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Funding

None of the authors received funding for their collaboration in this study.

Author information

Authors and Affiliations

  1. Department of Plastic Surgery, AZ Monica General Hospitals, Antwerp, Belgium

    Steven D. M. Colpaert, Astrid Heeren & Marc Van Cleemput

  2. Senology Practice, Vasillisis Sofias Avenue 115, 11521, Athens, Greece

    Sarantos Papadopoulos

  3. Department of Plastic Surgery, Addenbrooke’s Hospital, Cambridge, UK

    Nadeem Akhtar

Authors
  1. Steven D. M. Colpaert
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  2. Astrid Heeren
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  4. Nadeem Akhtar
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  5. Marc Van Cleemput
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Corresponding author

Correspondence to Steven D. M. Colpaert.

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Consent to participate

Informed consent was obtained from all the individual participants included in the study.

Ethical approval

The AZ Monica ethics committee had no comments on the competence of the investigator and his staff, the suitability of the facilities and the protocol. The study was approved and can be conducted in our hospital. The ethics committee stresses that a favorable opinion does not signify that the committee assumes responsibility for the study.

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The authors affirm that participants provided informed consent for publication of the images in Figs. 1, 2, 3, 4, 5 and 6.

Conflict of interest

The authors Steven D. M. Colpaert, Astrid Heeren, Sarantos Papadopoulos, Nadeem Akhtar and Marc Van Cleemput declare no competing interests.

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Colpaert, S.D.M., Heeren, A., Papadopoulos, S. et al. Diagonal upper gracilis (DUG) flap for autologous breast reconstruction: a case series. Eur J Plast Surg 46, 367–376 (2023). https://doi.org/10.1007/s00238-022-02013-5

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