Ann Plast Reconstr Surg | Volume 8, Issue 1 | Case Report | Open Access
Shefler H*, Freidin D and Tissone A
Department of Plastic and Reconstructive Surgery, The National Burn Center, Sheba Medical Center, Israel
*Correspondance to: Hadas Shefler
Fulltext PDFDeep Inferior Epigastric Artery Perforator (DIEP) flap technique has gained prominence in autologous breast reconstruction procedures. Preoperative imaging, particularly contrast-enhanced Computed Tomography Angiography (CTA), has emerged as the gold standard for comprehending the flap's intricate anatomy. Meanwhile, femoral hernias, constituting 4% of groin hernias, frequently yield discomfort and pain. Surgical approaches to rectify these hernias encompass the Cooper ligament method, preperitoneal technique, and laparoscopic intervention. Successful repair necessitates meticulous sac dissection, defect closure, and potential mesh integration, with laparoscopy gaining favor for bilateral groin hernia correction.
Contraindications for DIEP flap encompasses factors such as previous abdominoplasty, inadequate flap blood supply, severe obesity, uncontrolled diabetes, and debilitating cardiovascular conditions. Relative contraindications involve smoking and patient motivation. Notably, bilateral inguinal or femoral hernia repair with mesh remains non-contraindicated and is undocumented in the literature.
We present a case study of a 64-year-old female with cardiovascular comorbidities undergoing unilateral breast reconstruction after mastectomy. Notably, she had previously undergone laparoscopic bilateral femoral hernia repair with mesh. While preoperative CTA indicated patent blood vessels, the intraoperative exploration of the DIEP flap revealed mesh fragments adhered to vasculature, rendering vessel separation arduous. Surgical choices included terminating the autologous procedure or proceeding with compromised vessel separation.
The procedure continued with the flap elevated alongside mesh-attached vessels, followed by meticulous anastomosis. To prevent mesh-related complications, fragments were secured to the chest wall, mitigating the risk of rupture near the anastomotic sites. Despite the unfavorable odds, the patient achieved successful recovery with flap integrity.
In conclusion, our case underscores the challenges posed by mesh remnants in autologous breast reconstruction using the DIEP flap technique. It demonstrates the surgical adaptability required to navigate unexpected complexities, ensuring successful outcomes in the face of challenging conditions. Further research is warranted to enhance understanding and address unforeseen challenges in autologous breast reconstruction procedures.
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Shefler H, Freidin D, Tissone A. Abdominal Surgeries Prior DIEP Flap Breast Reconstruction - Case Report. Ann Plast Reconstr Surg. 2024; 8(1): 1113..