2. SIEA flaps lead to an increase in abdominal
seroma rates compared to DIEP flaps for breast
reconstruction.
Moradi P, DurrantC, Glass GE, AskouniE, Wood
S, Rose V
Charing Cross Hospital, London
3. Introduction
• The transverse paddle of lower abdominal
tissue remains the tissue of choice in breast
reconstruction as it is unmatched for both its
quality, quantity and aesthetic results.
4. Introduction
• The methods of autologous tissue breast
reconstruction has evolved:
– Pedicled TRAM
– Free TRAM
– Muscle-sparing free TRAM flaps,
– DIEP
– SIEA
5. Introduction
• Each variation in this progression has resulted
in the harvest of decreasing amounts of rectus
abdominis muscle and anterior rectus fascia
• Aims is to minimise donor site morbidity
without compromising flap viability.
6. • The superficial inferior epigastric artery (SIEA)
flap was described as early as 1975 by Taylor
and Daniel
• Its use for breast reconstruction was first
described in a case report by Grotting in 1991
7. • Wu (PRS 2008) has looked at SIEA patient’s
subjective perception of abdominal wall
function, and rated them more
favourablethan their DIEP flap counterparts
– thus supporting the notion of improved
abdominal donor site morbidity.
8. • SIEA flaps may be associated with an increase
in seroma rate compared to DIEP/TRAM flaps
– Allen et al Seminars in Plastic surgery 2002
– Granzow et al JPRAS 2006
• This has not been quantified in the literature.
9. The SIEA pedicle passes superiorly and laterally
in the femoral triangle, supplying lymph nodes
before piercing the cribiform fascia to travel in
the subcutaneous tissue superficial to Scarpa's
fascia.
10. • Granzowin their report of 228 SIEA
flaps, report an increased seroma rate when
compared to DIEP flaps,
– attribute this to the course of the SIEA through
the groin lymphatic bed, which it nourishes.
11. Aim
• Does SIEA flap really result in lower donor site
morbidity compared to DIEP flaps?
12. Aim
• In our SIEA and DIEP patients we evaluated:
– Post-operative abdominal drain volumes
– Abdominal donor site seroma rates
– Length of hospital admission
13. Patients and Methods
• All patients who underwent breast
reconstruction using lower abdominal
autologous tissue at the Charing Cross
Hospital between February and November
2009
14. Patients and Methods
• 39 patients (43 flaps)
• 7 patients had a SIEP flap reconstruction
– 6 unilateral and 1 bilateral.
• 28 patients had a DIEP flap reconstruction,
– 27 unilateral and 1 bilateral.
15. Patients and Methods
• 4 patients (6 flaps) were excluded from our
study:
– 2 of which had a muscle-sparing TRAM
reconstruction
– 2 had bilateral reconstructions where one side
utilised a SIEA and the other side a DIEP.
16. Patients and Methods
• SIEA flaputilised in 10/43 (23%) flaps, which is
similar to other published studies
– 31% Speigel et al PRS 2007
– 30% Chevray et al PRS 2004
17. There were several anatomic criteria that had to
be met for an SIEA flap reconstruction to be
performed
1: SIEA with a palpable and visible arterial
pulsation and a minimum external diameter of
1.0 mm at the level of the lower abdominal
incision
2: CT angiography tovisualisethe caliber, location
and direction of the SIEA
18. If the above criteria were met
• Minimal dissection of the SIE pedicle was
performed at the level of the lower abdominal
crease
– to avoid unnecessary groin dissection
• DIEP flap raised in the usual manner.
– microvascularclamps placed on the perforators
and the flap was isolated on the superficial
inferior epigastric vessels.
19. • Clinical evaluation of the perfusion of the flap
was performed and if deemed appropriate
– SIEV were dissected to their origins from the
femoral vessels
20. Drain
• All patients had abdominal drains
inserted, and cumulative drainage
measurements were taken every 24 hours.
• Once the drainage was less than
40mls/24hours the drains were removed.
21.
22. Results
• Mean drainage volume in the SIEA group was:
– 2248mls
• Mean drainage volume in the DIEP group was:
– 531mls
– P=0.029
23. Results
• Obesity (BMI>30) did not appear to influence
drainage volumes in the DIEP (p=0.81) group.
• In the SIEA group, the obese did tend to drain
more, although this did not reach significance
(P=0.154).
24. Results
• Length of stay:
– SIEA group 10.4 days
– DIEP group 9.1 days
• p=0.351
• Chevray(PRS 2004) were able to show that patients
with a SIEA compared to DIEP reconstruction
required an average of 1 day less in the
hospital.
26. Conclusion
• The SIEA does not involve incision or excision
of rectus abdominis muscle or fascia:
– Its harvest is the least invasive and quickest method
of obtaining lower abdominal tissue for breast
reconstruction.
– The conclusion that abdominal donor-site morbidity
is minimised is therefore reasonable
27. Conclusion
• In our series we found that the SIEA flap was
associated with:
– a significant increase in abdominal drain volume
relative to the DIEP flap,
– which translated to an extra day in hospital
