DIEP Flap: A Useful Option in Reconstruction of Complex Lower Limb Trauma in Men

Abstract

With increasing advancements in reconstructive surgery, limb salvage is attempted even in extensive lower limb trauma. However, when faced with large soft tissue defects and exposure of critical structures, traditional options like the latissimus dorsi and anterolateral thigh flaps often fall short, owing to excessive bulk, positioning challenges, donor site morbidity, or limited flap dimensions. The deep inferior epigastric artery perforator (DIEP) flap, although first used for nonbreast indications, is now widely used in breast reconstruction, and remains underutilized in lower limb trauma.

We present a retrospective analysis of all patients who underwent lower limb reconstruction using DIEP flaps from December 2019 to September 2023. Patient demographics, flap details, complications, and outcomes were studied.

DIEP flaps were used in 13 male patients, with a mean age of 36.6 years. The oblique design was most used (6 flaps). One flap was bipedicled; all others were unipedicled, with either one or two perforators. Flap size ranged from 120 to 480 cm2. Primary closure of the donor site was possible in all except one patient. Three flaps underwent total necrosis and one had partial necrosis (50%) requiring grafting. One flap underwent secondary debulking. No donor site hernias or bulges were noted.

The DIEP flap can be considered as an option for lower limb reconstruction when large flaps with long pedicles are required. It offers the advantage of a large skin paddle, primary donor site closure, and good vessel match for lower limb recipient vessels. Though there is an initial learning curve, with proper planning and technique, it can be a dependable choice in complex trauma reconstruction, in patients with a favorable abdominal morphology, especially when other flap options are unsuitable to be used.