Umbilical Complications Following DIEP Flap Breast Reconstruction: Demonstrating the Added Benefit of Preoperative Imaging.
Academic Article
Overview
abstract
BACKGROUND: Despite the umbilicus being an essential aesthetic unit, current literature in umbilical outcomes following abdominally based breast reconstruction is limited. In this study, we aim to elucidate the incidence and predictors of umbilical complications following DIEP flaps, with a particular emphasis on past abdominal surgery by type and measures that can be easily obtained from preoperative imaging. METHODS: An IRB-approved retrospective review of 258 patients who underwent DIEP flap reconstruction from 2011 to 2020 was performed. Patient demographics, preoperative labs, and intraoperative factors were appraised. Preoperative CTA or MRA was used to measure umbilical stalk height, abdominal wall thickness, and total fascial diastasis. Patients with and without perfusion-related umbilical complications were compared. RESULTS: Forty patients (15.5%) developed umbilical complications, including 20 patients with epidermolysis/scab, 12 with dehiscence, and 14 with partial necrosis. Patients with complications had a significantly higher rate of hypertension, prior abdominal midline incision, more lateral perforators per flap, longer umbilical stalk, and larger stalk height to abdominal wall thickness ratio (p<0.05). Logistic regressions revealed that stalk height (p=0.006) and stalk height to abdominal wall thickness ratio (p<0.001) were the only significant predictors, with the latter having a greater area under the receiver operating characteristic curve (AUC=0.79, p<0.001). CONCLUSIONS: Radiographic measurements of umbilical stalk height and stalk height to abdominal wall thickness ratio reliably predict the occurrence of umbilical complications, with the ratio having a more robust predictive ability. We propose the use of routine preoperative imaging to identify high-risk patients who may benefit from prophylactic measures.
