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Higher rates of failure, complications found with SIEA vs. DIEP flaps in breast reconstruction

Compared with deep inferior epigastric artery perforator flaps, superficial inferior epigastric artery flaps had a significantly higher incidence of re-exploration, necrosis, arterial complications and failure, according to recently published study findings.

Consecutive flaps from 7 years (2007 to 2013) of a single microsurgeon’s practice were reviewed retrospectively, with data from 112 patients included in the study. Arterial complications were analyzed in 44 flaps for breast reconstruction with superficial inferior epigastric artery (SIEA) flaps and compared with 125 deep inferior epigastric artery perforator (DIEP) flaps. All patients included in the review had a minimum 1 year of follow-up.

Results showed nine of the 44 SIEA flaps (20%) required re-exploration compared with nine of the 125 DIEP flaps (7%). Re-exploration for arterial insufficiency was significantly higher in SIEA flaps at 14%, compared with 1% of DIEP flaps. Additionally, arterial thrombosis was observed in all six SIEA flaps with arterial insufficiency, according to the researchers.

More SIEA flaps demonstrated complete failure compared with DIEP flaps, with failure occurring in six SIEA flaps vs. two DIEP flaps. Necrosis requiring intervention was also significantly more common among SIEA flaps compared with DIEP flaps.

According to researchers, the SIEA flap has a steep learning curve, among other limitations to its use in surgical practice. Therefore, the researchers concluded SIEA flaps should only be performed in centers with necessary experience and proven success rates. - by Abigail Sutton

Disclosure: The researchers report no relevant financial disclosures.