Seguridad y complicaciones en reconstrucción mamaria autóloga con colgajo DIEP: una revisión sistemática

Autologous free flap breast reconstruction may be associated with complications related to the flap and the donor site. Our objective was to evaluate the reported evidence on safety, complications and risk factors in patients undergoing deep inferior epigastric artery perforator flap (DIEP) breast reconstruction. A systematic review was conducted based on a Medline search for studies published between September 1995 and September 2015. Demographic data, flap dimensions and complication rates were recorded including total flap necrosis, partial flap necrosis and fat necrosis. A total of 34 clinical studies including 35 case series, 2,761 patients and 3,927 DIEP flaps were identified. The mean body mass index was higher than 24.5 kg/m2 whereas the obesity rate was above 14.5%. None of the articles reported flap weight, area or volume after molding. Total and partial flap necrosis rates were 1.9% (75/3,811) and 2.6% (68/2,575), respectively. Fat necrosis was diagnosed in 8.2% (308/3,746) of flaps with a standard deviation of 6.9. Reoperation was required in 5.5% (107/1,940) of the flaps. The incidence of hematoma in the recipient site and abdominal hernia or bulge formation was 3% (59/1,952 flaps and 52/1,725 patients). In conclusion, the occurrence of complications in breast reconstruction by autologous DIEP flap was low, although the occurrence of fat necrosis ranged widely.