NESPS Home  |  Past & Future Meetings
The Northeastern Society of Plastic Surgeons

Back to 2021 Abstracts


Perforator Characteristics and Impact on Post-operative Outcomes in DIEP Flap Breast Reconstruction: A Systematic Review & Meta-Analysis
Pathik Aravind, MBBS, Shashank Reddy, MD, PhD, Salih Colakoglu, MD, Alexander Sun, MD, MHS
Department of Plastic & Reconstructive, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Background: DIEP flaps are one of, if not the most common technique for autologous breast reconstruction. Despite this, high-quality evidence on perforator selection is lacking and is a subject of continuous debate among plastic surgeons. Thus, we aimed to systematically review the literature to analyze perforators characteristics and their impact on DIEP flap breast reconstruction outcomes.
Methods: We conducted a systematic review and meta-analysis across five databases: ClinicalTrials.gov, Medline, Ovid Embase, PubMed, and Web of Science for all studies on DIEP flap breast reconstruction focused on perforator characteristics caliber, number, and location. Risk of bias assessment was done using the ROBINS scale. The primary objective was to analyze the impact of perforator characteristics on partial and/or total flap failure and fat necrosis. Data analysis was done using RevMan V5.3.
Results: The initial search gave us 2768 articles of which 17 articles were included. Our study included 3800 patients with 4322 autologous flap reconstructions, of which 3881 (89.8%) were DIEP flaps. Mean age was 48.1 years and mean BMI was 27.8, across studies. Mean follow-up time was 18.6 months (Range=1-107). Overall rate of partial and/or total flap failure was 2.5%, reported in 10 studies. Pooled analysis did not show statistically significant correlation between partial and/or total flap failure and perforator number (OR=1.8, 95% C.I.=0.6-5.1, I2=0%), or perforator location (OR=1.6. 95% C.I.=0.5-4.4, I2=0%). Overall rate of fat necrosis was 12.4% reported across 13 studies. For fat necrosis, initial analysis including all relevant studies also did not show a statistically significant correlation to perforator number (OR=1.7, 95% C.I.=0.8-3.4, I2=78%) or location (OR=1.9, 95%=0.8-4.8, I2=80%). However, there was a high level of heterogeneity in these analyses. Sensitivity analysis accounting for heterogeneity across studies showed that, the odds for fat necrosis was statistically significantly higher when single perforator (OR=2.2, 95% C.I.=1.6-3.1) was used compared to a multiple perforators. Similarly, use of medial row perforators (OR=3.1, 95% C.I.=2.0-4.8) was also seen to be associated with higher odds of fat necrosis compared to lateral row perforators.
Conclusion: Our findings suggest that use of a multiple perforators and lateral row perforators are associated with lower rates of major post-operative complications. Adopting a standardized perforator selection algorithm may facilitate operative decision making, shorten the learning curve for surgeons just starting out and optimize post-operative outcomes by minimizing the burden of major complications. This in turn would help improve patient satisfaction and quality of life.


Back to 2021 Abstracts