Journal of plastic, reconstructive & aesthetic surgery : JPRAS · 2026
Optimizing the choice between single- and bipedicled DIEP flaps: A strategy guided by 3D volumetrics and indocyanine green angiography.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Xu Boyang, Liu Wenyue, Li Shangshan, Chen Zhaohan, Dong Hao, Hou Siyu, Luan Jie, Liu Chunjun
Аннотация
BACKGROUND: Determining the need for a bipedicled deep inferior epigastric perforator (DIEP) flap is a critical challenge in delayed breast reconstruction. The traditional, experience-based approach is often subjective and inaccurate. We aimed to evaluate a novel quantitative strategy to optimize this decision-making process.
METHODS: Patients undergoing delayed DIEP flap reconstruction managed with a new strategy were prospectively enrolled from January 2022 to December 2024, a historical conventional cohort served as the control. The quantitative strategy combines preoperative three-dimensional measurement to define the breast volume deficit with intraoperative indocyanine green angiography to assess real-time flap perfusion. Primary endpoints were the final volume restoration ratio (VRR), rate of bipedicled flap use, and flap-related complications. Follow-up was a minimum of six months. Multivariable logistic regression was performed to control for confounders and identify independent predictors of optimal volumetric symmetry (VRR 90-110%).
RESULTS: A total of 183 patients were included (Strategy: n = 82; Conventional: n = 101). The Strategy group demonstrated a significantly higher rate of bipedicled flaps (58.5% vs. 40.6%, p = 0.016) and optimal symmetry (45.1% vs. 25.7%, p = 0.010). Multivariable analysis confirmed the quantitative strategy as a significant independent predictor for achieving optimal symmetry (odds ratio 2.53; p = 0.005), after adjusting for demographics and defect size. The incidence of flap-related complications was significantly lower in the Strategy group (2.4% vs. 10.9%, p = 0.040).
CONCLUSION: This strategy provides objective guidance for selecting single-pedicle versus bipedicled DIEP flaps in delayed breast reconstruction and is associated with significantly improved postoperative symmetry while reducing flap-related complications.
METHODS: Patients undergoing delayed DIEP flap reconstruction managed with a new strategy were prospectively enrolled from January 2022 to December 2024, a historical conventional cohort served as the control. The quantitative strategy combines preoperative three-dimensional measurement to define the breast volume deficit with intraoperative indocyanine green angiography to assess real-time flap perfusion. Primary endpoints were the final volume restoration ratio (VRR), rate of bipedicled flap use, and flap-related complications. Follow-up was a minimum of six months. Multivariable logistic regression was performed to control for confounders and identify independent predictors of optimal volumetric symmetry (VRR 90-110%).
RESULTS: A total of 183 patients were included (Strategy: n = 82; Conventional: n = 101). The Strategy group demonstrated a significantly higher rate of bipedicled flaps (58.5% vs. 40.6%, p = 0.016) and optimal symmetry (45.1% vs. 25.7%, p = 0.010). Multivariable analysis confirmed the quantitative strategy as a significant independent predictor for achieving optimal symmetry (odds ratio 2.53; p = 0.005), after adjusting for demographics and defect size. The incidence of flap-related complications was significantly lower in the Strategy group (2.4% vs. 10.9%, p = 0.040).
CONCLUSION: This strategy provides objective guidance for selecting single-pedicle versus bipedicled DIEP flaps in delayed breast reconstruction and is associated with significantly improved postoperative symmetry while reducing flap-related complications.