Does the Difference in Vascular Anatomy in the Multiple Perforator DIEP Flap Affect the Flap Dissection Time?

[BACKGROUND] Multiple perforator deep inferior epigastric perforator (DIEP) flaps demonstrate superior perfusion. The selection of perforators is influenced by several factors, including the number of perforators, the running layer, the pedicle length, and the branching pattern. This study aimed to investigate the relationship between the basic and anatomical characteristics and flap dissection time in patients undergoing unilateral breast reconstruction using multiple perforator DIEP flaps.

[METHODS] This was a cohort study including 134 patients. Patients were divided into 2 groups based on the flap dissection time: short-time and long-time groups. The anatomical characteristics of the perforators were analyzed using preoperative and intraoperative images. The lengths of the submuscular and intramuscular vessels were measured, and the intramuscular course rate was calculated.

[RESULTS] The short-time group demonstrated significantly lower intramuscular course rates (mean, 43.6% vs 50.3%; P = 0.006), elevated flap weights (629.1 vs 886.9 g, P = 0.04), total operative time (419.9 vs 457.3 minutes, P < 0.001), and vertical and horizontal flap widths (10.2 vs 10.7 cm, P = 0.02; 31.6 vs 35.2 cm, P = 0.004, respectively). The multivariate analysis indicated that the intramuscular course rate ( P < 0.001) and horizontal flap width ( P = 0.044) were significant predictors of flap dissection time.

[CONCLUSIONS] Perforators with an intramuscular course may be associated with a higher likelihood of increasing flap dissection time. The perforator running layer should be considered when selecting the pedicle side.