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Comparing Donor Site Outcomes in DIEP Flap Reconstruction: A Retrospective Analysis of Mesh Reinforcement with SurgiMend and Ovitex
Matthew Seebald^*1, Arnav C. Mahajan¹, Benjamin Eichelman¹, Bharat Ranganath², Sean Wallace^2
1George Washington School of Medicine and Health Sciences, Washington, ; ²Surgery, George Washington Hospital, Washington,

Background:
This study evaluates donor site bulge and hernia incidence after deep inferior epigastric perforator (DIEP) flap reconstruction with SurgiMend PRS or Ovitex underlay reinforcement, compared to no-mesh (NM) primary fascial closure.

Methods:
A retrospective chart review was conducted on DIEP flap reconstructions at George Washington Hospital (January 2020-February 2025). Patients were categorized by abdominal wall reinforcement: SurgiMend, Ovitex, or NM. Data included demographics, preoperative risk factors, and donor site complications (hernias, bulges, seromas, wound breakdown, infections). Chi-squared tests compared complications, while multivariate logistic regression adjusted for age, BMI, prior treatment, cancer status, and mesh type, using NM as the reference.

Results:
A total of 131 patients (225 flaps) were included: 34 NM, 53 Ovitex, 45 SurgiMend. Among them, 88 had cancer, 22 had DCIS/LCIS, and 21 underwent prophylactic surgery. Prior chemo- and radiotherapy were noted in 23 and 39 patients, while 65 had immediate reconstruction.
Donor site wound breakdown was most common (NM = 6, Ovitex = 9, SurgiMend = 3; p = 0.84). Other complications included bulges (NM = 5, Ovitex = 3, SurgiMend = 5; p = 0.362), seromas (NM = 6, Ovitex = 3, SurgiMend = 5; p = 0.206), and infections (NM = 1, Ovitex = 3, SurgiMend = 3; p = 0.757). No hernias were observed.

Multivariate analysis (Table 1) found lower odds ratios for bulging (Ovitex = 0.32, p = 0.154; SurgiMend = 0.70, p = 0.607), seromas (Ovitex = 0.23, p = 0.065; SurgiMend = 0.59, p = 0.438), and donor site breakdown (Ovitex = 0.83, p = 0.762; SurgiMend = 0.72, p = 0.623), but a higher odds ratio for infection (Ovitex = 1.75, p = 0.650; SurgiMend = 3.00, p = 0.374). None of these differences were statistically significant. BMI significantly predicted wound breakdown (OR = 1.12, p = 0.015).

Conclusions:
No significant differences in donor site complications were found between Ovitex and SurgiMend. Larger studies are needed to assess mesh reinforcement's role in optimizing outcomes.
Multivariable Analysis of Donor Site Complications

Mesh	Bulge OR (95% CI)		Seroma OR (95% CI)	Donor Site Wound Breakdown OR (95% CI)	Donor site infection OR (95% CI)
Ovitex	0.32 (0.07-1.53), p=0.154		0.23 (0.05-1.09), p=0.065	0.83 (0.25-2.79), p=0.762	1.75 (0.16-19.75), p=0.650
SurgiMend	0.70 (0.18-2.76), p=0.607		0.59 (0.15-2.25), p=0.438	0.72 (0.20-2.64), p=0.623	3.00 (0.27-33.96), p=0.374

Predictors not shown: BMI, Age, Prior Treatment, Cancer Status

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