104 DIEP Flaps Requiring a Return to Theatre: A Local Assessment of Flap Salvage and Failure Rates and the Intraoperative Events Predicting Flap Complications

Aim

The deep inferior epigastric perforator (DIEP) flap is widely used in breast reconstruction. We assessed DIEP flap salvage and failure rates at a tertiary centre in the United Kingdom and examined whether intraoperative complications predicted a return to theatre.

Method

Outcomes of 220 DIEP flaps (between 2013-2024) from a single surgeon at a tertiary centre in the United Kingdom were reviewed. Cases requiring a return to theatre within 48 hours (n=12) were compared with a random sample of successful flaps (n=22) to identify intraoperative predictors of post-operative complications.

Results

5.5% (12/220) of flaps required a return to theatre due to features of impending flap failure: ischaemia, venous congestion, or haematoma. Of these, 41.6% (5/12) were salvaged, while 3.2% (7/12) failed, resulting in an overall failure rate of 3.2% (7/220). These results compare favourably with national rates.

Review of operation notes revealed intraoperative complications in 67% of cases that subsequently required a return to theatre. This included vessel thrombosis, vessel placement (twisting), venous congestion, anastomotic leakage, haematoma, or vessel damage. Conversely, only 13% of successful flaps had similar intraoperative complications (Chi-squared test, p=0.001).

Conclusions

Given the low salvage rate of failing DIEP flaps, intraoperative complications should be addressed comprehensively, on table, during the initial surgery to avoid post-operative flap failure. When these complex cases do arise, the on-call plastic surgery team should be alerted for vigilant monitoring during the first 48 hours, with a low threshold for re-exploration. These findings inform patient counselling and consent discussions.