I Had a Bi Lateral Delayed DIEP on June 10. My Abdominal Sutures Have Opened Twice and Are Tunneling Now. I Have Two Options:

Of course without an examination and review the records it is difficult to guide you better.Three
basic forms of breast reconstruction exist. You can use your own tissue,
implants or a combination of the previous two techniques. Your own tissue can
be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting.
Implants can be done in one stage or two stage. Two stage reconstructions are
started by placing expanders at the time of mastectomy. Once they expanders are
placed they are able to be inflated as determined by wound healing. The final
time consists of combining any of the above techniques.



If
you are interested in being seen in Austin please give us a call. I know
this is a difficult time for you. The majority of my practice is devoted
to reconstruction for women with breast cancer or who are BRCA+

Thank you for your question.   I see this problem on rare occasion in patients that have a thick fat pad on their abdominal wall.  I have had excellent success by being aggressive and returning to the operating room for an outpatient procedure where the unhealthy tissue is debrided and skin closed over a few large drains.    If this fails, wound vac is always a good back up plan.  Luckily, I have not had to wound vac a patient after diep flap with returning to the OR for debridement and closure with drains.

In most cases this is an issue of lack of blood supply due to the thick abdominal skin flap or fat necrosis.    For this reason, during the diep flap closure,  I try to avoid undermining of the skin in these patients and I prefer to place very little deep sutures and multiple subdermal and subcuticular sutures.   My rationale is that the deeper sutures can be a source of infection due to fat necrosis and we all know that fat is very poorly vascularized.   Also, by minimizing the undermining of the skin flap, the blood supply is minimally disrupted giving every opportunity to allow the skin incision to heal safely.

I have had great success in the abdominal incision  of obese patients after bilateral diep flap with this method.

Dr. GIll

Abdominal dehiscence can happen and local wound care of use of a VAC should allow the wound to close.

It seems  you have some sort of wound healing problems after the delay of the DIEP flap.Either fat necrosis or infection. Either way it requires aggressive treatment measures. Surgical debridement, or wound vac are good ways to treat. If there is infection, treat the infection.  You may have to re-evaluate the method of reconstruction after the wounds are healed completely