Bipedicled Abdominal Free Flaps Utilizing the Superior Continuity of the DIEP Vascular Pedicle in Breast Reconstruction: Case Reports of New Hamdi Type II DIEA/SIEA Flaps

The Deep Inferior Epigastric Perforator (DIEP) flap is an excellent superior option for autologous breast reconstruction, and considered the gold standard by many following mastectomy, associated with high patient satisfaction and low donor-site morbidity. The traditional single pedicle arrangement may not always provide enough tissue, particularly if trying to match the contralateral breast and this may be a pertinent feature in patients who are slim, post massive weight-loss, had previous liposuction or have a midline abdominal scar. Bipedicled (double pedicle) or stacked configurations of the DIEP flap provide new concepts in flap design, which may overcome some of these precluding features. The use of a double pedicle for unilateral reconstruction can maximize the amount of lower abdominal tissue harvested by recruitment of zone IV territories, and augmenting the overall vascular supply to the flap. This chapter discusses the indications for bipedicled DIEP reconstructions and includes case studies for intra-flap vascular constructs combining DIEA “continuities” with a contralateral SIEA hemi-abdominal flap.