A Classification System for Partial and Complete DIEP Flap Necrosis Based on a Review of 17,096 DIEP Flaps in 693 Articles Including Analysis of 152 Total Flap Failures

Abstract

BACKGROUND: In a comprehensive review of 17,096 deep inferior epigastric perforator (DIEP) flaps in 693 articles published between the first description of the DIEP flap in 1989 and August of 2011, the authors found that the methods used to categorize partial necrosis and fat necrosis were inconsistent. As a result, these surgical outcomes cannot be meaningfully compared among series and centers. In contrast, complete flap failure is an unambiguous and universally reported outcome that represents only a portion of the entire spectrum of flap necrosis. METHODS: The authors created a database of every article with data on DIEP flaps by searching PubMed and Embase for the terms "DIEP," "DIEAP,"..