The Impact of Retrorectus Vicryl Mesh on DIEP Donor Site Morbidity: A Propensity Score-Matched Analysis

INTRODUCTION: Donor site morbidity following deep inferior epigastric artery perforator (DIEP) flap harvest, particularly hernias and bulges, can cause significant aesthetic and functional challenges. This study evaluates the impact of retrorectus polyglactin (Vicryl) mesh placement on abdominal morbidity. METHODS: A retrospective, single-center study was conducted on patients undergoing autologous DIEP flap-based breast reconstructions between March 2018 and September 2023. Propensity score matching was employed to mitigate selection bias, while multivariable regression analysis addressed potential confounding factors. RESULTS: A total of 554 DIEP flap reconstructions in 357 patients were identified, with 112 (31%) receiving a retrorectus polyglactin mesh. Unmatched comparisons demonstrated significantly lower rates of hernia (0.9% vs. 6.5%, p=0.02) and bulge (0.9% vs. 7.3%, p=0.01) with mesh placement, although cellulitis rates were significantly higher (8.9% vs. 3.7%, p=0.04). In propensity-matched comparisons, no significant differences were found in the rates of postoperative hernias, bulges, abscess formation, seroma, cellulitis, hematoma, skin necrosis, wound dehiscence, or delayed wound healing between the mesh and no-mesh groups, Table. Univariate regression analysis identified mesh as the sole factor significantly associated with reduced bulge occurrence (OR=0.1, p=0.035). Multivariable regression, adjusted for follow-up duration, indicated that mesh placement was not an independent predictor of hernia (OR=0.5; p=0.58). However, advanced age (OR=1.1; p<0.001), prior open abdominal surgery (OR=0.1; p=0.0.17), previous radiation therapy (OR=0.1; p=0.01), lateral row perforator harvest (OR=46.5; p=0.004), and the number of harvested medial row perforators (OR=2.6; p=0.012) were identified as independent predictors. CONCLUSION: Retrorectus polyglactin mesh placement is significantly associated with decreased bulge rates but does not independently reduce the risk of hernia following DIEP flap harvest.