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Plast Aesthet Res 2018;5:6 I http://dx.doi.org/10.20517/2347-9264.2018.08 Page 15 of 17

24. Combined TUG PAP using SPY as an aid in perineum reconstruction

Karen Lo, David Mathes, Tae Chong

University of Colorado

In perineal reconstruction, the goals are to provide coverage and eliminated dead space in an area prone to
wound problems. The VRAM flap has traditionally been used due to its bulk and ease of transfer at the time
as the oncologic surgery. However, when the abdomen is not available, other flaps are considered. We present
the case of perineal reconstruction using combined TUG and PAP, with SPY angiography as an aid. KM a 59
yo F with h/o stage 3c invasive rectal adenocarcinoma s/p neoadjuvant chemoradiation. We planned a VRAM
at the time of oncologic resection. However, she had positive margins; thus, underwent an APR, omental flap,
mesh placement, hysterectomy and partial vaginectomy by her cancer surgeons. They placed a WV stating
they did not want flap closure. A week later we were re-consulted for flap closure. As the VRAM was no longer
an option, we decided on a thigh based flap. A doppler was used to identify the locations of the perforator for
the TUG, ascending branch of the medial circumflex femoral artery, and the PAP, profunda artery. The PAP
was clamped and we used SPY angiography to evaluate the perfusion based on the TUG alone. We noted poor
perfusion of the distal skin paddle, which we intended to use to recreate the vagina. Under SPY, we released the
clamp and saw immediate perfusion of the distal skin paddle and thus used both the PAP and the TUG in the
reconstruction. The pt was discharged home without issues.

25. Delayed DIEP flap loss: a complication of microvascular progress and earlier discharge

Alicia Heelan Gladden, Becky B. T. King, Alexandra Kovar, Kristen Ohe, Colleen Murphy, Joyce
Aycock, David Mathes, Tae Chong

University of Colorado

Aim: Traditional teaching is that microvascular complications most frequently occur in the early post-
operative period, typically within 48 h. The purpose of this study was to investigate deep inferior epigastric
perforator (DIEP) total flap loss at our institution.

Methods: A retrospective analysis of patients who underwent DIEP flap breast reconstruction at a single
institution was performed. Pre-operative demographic data and post-operative complications were recorded.
Delayed flap loss was defined as non-salvageable flap presenting greater than 48 h after surgery.

Results: Eighty-eight patients underwent 137 DIEP flaps during the study period. Five patients (3.6%) had
threatened flaps in the first 48 h post-operatively and three of these were salvaged with emergent operative
intervention. Five patients suffered total flap loss (3.6%). Sixty percent (3/5) of flap losses occurred after
patient discharge, with all three patients returning the day after discharge with a non-salvageable flap. When
patients with early microvascular complications were compared to the delayed flap loss group, there were
no significant differences in age, BMI, smoking status, diagnosis of diabetes or hypertension, radiation, or
timing of reconstruction (all P > 0.05).

Conclusion: Over half of our institutions flap losses were delayed, occurring after discharge. This finding
contradicts the notion that most flap losses occur in the immediate post-operative period. The advancement
of microsurgical techniques is reducing the frequency of flap loss during this early period, when flaps are