An Intraoperative Algorithm for Use of the SIEA Flap for Breast Reconstruction

Background: The deep inferior epigastric perforator (DIEP) flap has been shown to be a reliable option for breast reconstruction. A further refinement in the transfer of lower abdominal tissue for breast reconstruction is the superficial inferior epigastric artery (SIEA) flap. A retrospective study was conductedtoassessthereliabilityandexaminetheoutcomesofSIEAflapsforbreast reconstruction while considering an intraoperative algorithm established in this study. Methods: Ninety-nine SIEA flap reconstructions were performed in 82 patients in a 3½-year period. Patients were divided into two groups (before and after algorithm implementation), and their medical records were evaluated with respect to demographic information, tumor type, tobacco use, ischemic time, flap weight, and complications. Potential risk factors for complications were also assessed. Results: Of the first 72 SIEA flaps, five were lost because of arterial thrombosis. All failed flaps had an SIEA diameter of less than 1.5 mm at the level of the lower abdominal incision. In February of 2004 (point T), the senior author (A.J.S.) implemented an intraoperative algorithm for flap selection that allowed use of the SIEA flap only when the SIEA diameter was 1.5 mm or greater than. In the remaining cases, a DIEP flap was used for breast reconstruction. After point T, 27 SIEA flap procedures were performed without any flap losses. Overall fat necrosis and partial flap loss rates were 1.0 and 5.1 percent, respectively. No abdominal bulges/hernias were observed. Only smoking at the time of surgery was associated with increased donor-site complications (p 0.016). Conclusion: The intraoperative algorithm helped decrease flap and abdominal complication rates for the SIEA flap. (Plast. Reconstr. Surg. 120: 1450, 2007.)