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The Pfannenstiel scar and its implications in DIEP flap harvest: a clinical anatomic study

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Abstract

Background

Despite the utility of the deep inferior epigastric artery perforator (DIEP) flap, the presence of abdominal wall scars can limit flap perfusion. Pfannnstiel scars are among the most common abdominal scars, during which undermining at either a subfascial or suprafascial level can damage perforators. There is an anecdotal belief that raising a DIEP flap in the presence of a Pfannenstiel scar may be less reliable due to vascular disruption.

Methods

A clinical prospective analysis of retrospectively recorded imaging from 150 patients (300 hemi-abdominal walls) was undertaken. Preoperative imaging, with two computer software programmes used to reconstruct three dimensional (3-D) volume-rendered images and analyse vasculature, was used to accurately identify and measure perforators.

Results

A total of 959 perforators were identified, with 319 perforators identified in the ‘Pfannenstiel scar’ group and 640 perforators in the ‘no abdominal scar’ group. All patients, except for one patient with a Pfannenstiel scar, had one or more perforators that were larger than 1.0 mm in diameter. There were no differences in the number of DIEA perforators (6.81 vs 6.22, p = 0.2819); however, perforators of the ‘Pfannenstiel scar’ group were of larger mean diameter than the ‘no abdominal scar’ group (0.96 vs 0.85 mm (p = 0.0027).

Conclusions

The presence of a Pfannenstiel scar is associated with larger perforator size than controls and no diminution in overall perforator number. As such, a Pfannenstiel scar may in fact aid DIEP flap harvest, a finding consistent with anecdotal outcomes.

Level of Evidence: Level III, risk / prognostic study.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, 3199, Victoria, Australia

    Vachara Niumsawatt, Keli Chow, Xiao-You Shen, Warren Matthew Rozen & David J. Hunter-Smith

  2. Department of Surgery, Monash University, Level 5, E Block, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria, 3168, Australia

    Vachara Niumsawatt, Keli Chow, Xiao-You Shen, Warren Matthew Rozen & David J. Hunter-Smith

  3. Department of Surgery, School of Medicine and Dentistry, James Cook University Clinical School, Level 1, Townsville Hospital, 100 Angus Smith Drive, Douglas, Townsville, Queensland, 4814, Australia

    Warren Matthew Rozen

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  1. Vachara Niumsawatt
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  2. Keli Chow
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  4. Warren Matthew Rozen
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Corresponding author

Correspondence to Warren Matthew Rozen.

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Conflicts of interest

Vachara Niumsawatt, Keli Chow, Xiao-You Shen, Warren Matthew Rozen, and David J. Hunter-Smith declare that they have no conflict of interest.

Funding

There was no source of funding for the article. The authors declare that there is no source of financial or other support, or any financial or professional relationships which may pose a competing interest.

Ethical standards

All human studies were approved by institutional ethics, obtained through Peninsula Health HREC no. QA13PH5, and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Patient consent

All persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study were omitted.

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Niumsawatt, V., Chow, K., Shen, XY. et al. The Pfannenstiel scar and its implications in DIEP flap harvest: a clinical anatomic study. Eur J Plast Surg 39, 41–48 (2016). https://doi.org/10.1007/s00238-015-1176-0

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  • DOI: https://doi.org/10.1007/s00238-015-1176-0

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