Short Fasciotomy–Deep Inferior Epigastric Perforator Flap Harvest for Breast Reconstruction

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Abstract
Background: Despite several technical modifications to further reduce donor invasiveness in harvesting deep inferior epigastric perforator (DIEP) flaps, techniques with general applicability and demonstrating clinical benefits are scarce. The present study aimed to introduce a short-fasciotomy technique and evaluate its reliability, efficacy, and applicability by comparing with those of conventional methods. Methods: A retrospective study was conducted with 304 consecutive patients who underwent DIEP flap-based breast reconstruction, consisting of 180 using the conventional technique between October 2015 and December 2018 (cohort 1) and 124 implementing short-fasciotomy technique between January 2019 and September 2021 (cohort 2). In the short-fasciotomy technique, the rectus fascia was incised as much as that overlay the intramuscular course of targeted perforators. After intramuscular dissection, pedicle dissection proceeded without additional fasciotomy. Postoperative complications and fasciotomy-saving benefit were compared. Results: The short-fasciotomy technique was successfully adapted for all patients in cohort 2 regardless of length of intramuscular course and number of harvested perforators, with no case requiring conversion to the conventional technique. The mean length of fasciotomy in cohort 2 was 6.6 cm, significantly shorter than that in cohort 1 (11.1cm). The mean length of the harvested pedicle in cohort 2 was 12.6cm. No flap loss occurred in either group. The rate of other perfusion-related complications did not differ between two groups. The rate of abdominal bulge/hernia was significantly lower in cohort 2. Conclusions: The short-fasciotomy technique allows for less invasive DIEP flap harvest regardless of anatomical variability and provides reliable outcomes with minimal functional donor morbidity.

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