Predicting and planning for SIEA flap utilisation in breast reconstruction; an algorithm combining pre-operative computed tomography analysis and intraoperative angiosome assessment

Publication date: Available online 8 April 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Francis P. Henry, Daniel P. Butler, Simon H. Wood, Navid Jallali
BackgroundLow flap complication rates and excellent aesthetic outcomes are now commonplace in breast reconstruction. As a result, attention is now being focused on minimising donor site morbidity. Despite its potential donor site advantages, the SIEA flap is often discounted given concerns about the high flap failure rates. In this study we present out experience of using the SIEA flap in breast reconstruction and provide an algorithm based upon the pre-operative computed tomography angiogram (CTA) to aid pre-operative planning.MethodsA retrospective analysis of SIEA-flap breast reconstruction cases performed at our Unit between 2009 and 2016 was performed and outcomes assessed. In addition, the patients' pre-operative CTAs were assessed and compared to a matched group of patients who underwent a deep inferior epigastric flap breast reconstruction.Results26 patients who underwent SIEA-flap breast reconstruction were eligible for inclusion. No flaps were lost. Donor site seroma rate was 20%. The largest SIEA diameter in those undergoing an SIEA flap was found to be significantly larger (p=0.0001) than those who underwent a DIEP flap breast reconstruction. Significantly more patients that underwent a SIEA flap breast reconstruction were found to have an SIEA diameter greater than or equal to the largest DIEP flap perforator (p = 0.0001) than in the group where a DIEP flap was used for breast reconstruction.ConclusionHigh success rates can be achieved with abdominal flaps based on the superficial system with careful pre and perioperative assessment of patients.



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