THE DONOR SITE MORBIDITY OF FREE DIEP FLAPS AND FREE TRAM FLAPS FOR BREAST RECONSTRUCTION

This study was undertaken to demonstrate that the deep inferior epigas tric perforator (DIEP) flap can provide the well-known advantages of a utologous breast reconstruction with lower abdominal tissue while avoi ding the abdominal wall complications of the transverse rectus abdomin is myocutaneous (TRAM) flap. Eighteen unilateral free DIEP flap breast reconstruction patients were assessed 12-30 months (mean 17.8 months) after surgery. Clinical examination, physical exercises and isokineti c dynamometry were performed preoperatively and two months and one yea r postoperatively. Intraoperative segmental nerve stimulation, visual evaluation and postoperative CT scans were also used to quantify the d amage to the rectus muscle. The 18 patients were then compared with 20 free TRAM flap patients and 20 non-operated controls. Two DIEP flap p atients presented with abdominal asymmetry. A limited decrease of trun k flexing strength was noticed but rotatory function was intact. Ten o f the TRAM flap patients had umbilical or abdominal asymmetry, bulging or hernias. TRAM flap patients showed a statistically significant red uction in strength to flex and to rotate the upper trunk compared to b oth the one year postoperative DIEP flap group and the control group. The answers to a questionnaire revealed impairment of activities of da ily living for some TRAM flap patients while the activities of all DIE P flap patients were unaffected. Our data demonstrate that the free DI EP flap can limit the surgical damage to the rectus abdominis and obli que muscles to an absolute minimum. We believe it is worthwhile to spe nd extra operative time, the main disadvantage of this technique, to l imit late postoperative weakness of the lower abdominal wall.