Diep flap with anterior fascial island: The latest fashion for reconstruction of massive soft tissue defects

The DIEP flap has become the first choice for autologous breast reconstruction after total mastectomy and is also used for reconstructing various body parts. However, the reliance on a single vascular pedicle poses a risk of skin compromise in zone IV, potentially leading to necrosis. To reduce this risk, the extended DIEP transversal flap technique ensures sufficient blood supply to zone IV by utilizing dual deep inferior epigastric vessels or the superficial inferior epigastric artery (SIEA). This study outlines our experience in performing DIEP flap harvest in conjunction with the rectus fascia technique. In our retrospective analysis of ten patients-six for breast reconstruction and four for soft tissue defects-we found an average BMI of 20.1 kg/m² and an average flap size of 29 × 13 cm. The length of the flap's pedicle ranged from 9 to 14 cm. The anterior rectus sheath averaged 6.1 × 11.7 cm. All flaps survived, though one patient experienced 2 cm of necrosis at the distal edge of a pedicled DIEP flap. The conservation of the fascial plexus between the two perforators of the DIEP flap can provide the extra supply to the distal part of the flap, making zone IV viable. The total or extended DIEP flap, without additional anastomosis, helps reduce operation time, surgical complications, and other complications. The extended DIEP flap technique reduces operation time and complications, providing a viable option for reconstructing massive defects and breast reconstruction after mastectomy.