American Association of Plastic Surgeons

AAPS Home AAPS Home Past & Future Meetings Past & Future Meetings
Facebook   Instagram   Twitter   YouTube   LinkedIn

Back to 2024 Resident Posters


Another Look at the Medial and Lateral Rows: 18 Month Follow-up in Over 200 DIEP Flaps
Jacquelyn A Knox, MD, AIleen Gozali, MM, Serena Bhaskerrao, BS, Daniel Soroudi, BS, Scott Hansen, MD, Merisa Piper, MD
University of California, San Francisco, San Francisco, CA, USA

PURPOSE: The optimal choice between medial and lateral row perforators for deep inferior epigastric artery perforator (DIEP) flaps remains contested; the medial row has been associated with lower abdominal wall morbidity, and the lateral row with lower rates of fat necrosis. While many comparative studies exist, few report follow-up over 12 months. As these morbidities can take well over a year to declare themselves, we aim to investigate our institution’s long-term outcomes.
METHODS: We performed a retrospective review of patients who underwent mastectomy followed by DIEP reconstruction between November 2004-December 2021 with over 18 months follow-up. Post-operative outcomes were compared between flaps supplied by the medial row only, lateral row only, and a combination of both rows.
RESULTS: A total of 226 flaps were included: 172 lateral, 29 medial, and 25 combined. Obesity (BMI>30) was more prevalent in the lateral group (lateral: 50%, medial: 26%, combined: 26%, p=0.05), as was mesh use (lateral: 77%, medial: 47%, combined: 53%, p=<0.01). The rate of clinical fat necrosis was significantly higher in the medial group when controlling for obesity (medial: 31%, lateral: 9%, combined: 16%), p=0.04). We found no correlation with the number of perforators used. There were no significant differences in rates of hernia or bulge when controlling for obesity and mesh use (lateral: 10%, medial: 16%, combined:11%, p=0.54).
CONCLUSION: Our long-term follow-up suggests that perforator selection may not be associated with abdominal wall morbidity, but confirms previous studies’ findings that lateral row perforators yield the lowest rates of fat necrosis.


Back to 2024 Resident Posters