The Northeastern Society of Plastic Surgeons

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The Diagonal Upper Gracilis (DUG) Flap: A Review of 6 years of Outcome Data
Itay Wiser, MD, PhD, Elizabeth Kenworthy, MD, Babak Mehrara, MD, Joe Dayan, MD.
Memorial Sloan Kettering, New York, NY, USA.

Breast reconstruction using free flaps from thigh-based tissue has generally been considered a secondary option due to limited tissue availability and relatively higher donor site morbidity. The use of a diagonal upper gracilis (DUG) flap based on the thigh skin Langer lines allows both less tension on wound edges as well as avoidance of the femoral triangle and lymphatics within this area. This study aims to review flap dimensions and outcomes after DUG flap breast reconstruction.
A case series on patients who underwent breast reconstruction using a DUG flap. Data analyzed included patient demographics, operative flap dimension, length of follow-up and post-operative complications.
A total of 77 flaps were performed in 50 patients between April 2011 and December 2017. Twenty-seven patients had bilateral breast reconstruction, and 4 had unilateral stacked flaps. DUG was used for immediate reconstruction in 12 patients, and for oncoplastic reconstruction in 9 patients. Average flap skin paddle width was 9.6cm (n=48, SD=2.9, range=7-13), length was 21.5cm (n=48, SD=2.9, range=19-25), average flap weight was 326g (n=39, SD= 132.2, range=215-605). The overall flap complication rate was 6.5% and the overall donor site complication rate was 15.6% in 77 flaps/ donor sites. There were no flap loss events. The overall systemic complication rate was 2% in 50 patients (Pulmonary embolism). Two flap surgery had significantly more complications than one flap (37% vs. 13%, p=0.05).
Breast reconstruction using DUG free flaps is a safe and effective method of breast reconstruction especially in patients where there are no other autologous tissue options.

Flap Number
N%N%N%p Value
DVT/ PE00.0%13.7%12.0%0.35
Thigh Seroma/ Hematoma313.0%622.2%918.0%0.4
Thigh Cellulitis28.7%518.5%714.0%0.32
Fat Necrosis00.0%13.7%12.0%0.35
Total Complications313.0%1037.0%1326.0%0.05

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