Northeastern Society of Plastic SurgeonsImproving Surgeon Confidence in the DIEP Flap A Strategy for Reducing Operative Time With Minimally Invasive Donor SiteFeingold, Randall S. MDAuthor Information From the Department of Plastic and Reconstructive Surgery, North Shore-Long Island Jewish Health System, Albert Einstein College of Medicine, New York, NY. Received February 1, 2009, and accepted for publication, after revision, February 4, 2009. Presented at the 25th Annual Meeting of the Northeastern Society of Plastic Surgeons, Philadelphia, PA, October 2008. Reprints: Randall S. Feingold, MD, 833 Northern Boulevard, Suite 160, Great Neck, NY 11021. E-mail: [email protected]. Annals of Plastic Surgery: May 2009 - Volume 62 - Issue 5 - p 533-537 doi: 10.1097/SAP.0b013e31819fafdd Buy Metrics Abstract Criticisms of the DIEP (deep inferior epigastric perforator) flap include difficulties in perforator identification and dissection and prolonged operative times. Likewise, the stress level in such harvests varies considerably, particularly in bilateral breast reconstruction where 2 successful flap harvests are mandatory. Various operative strategies were explored in 100s of DIEP flaps to refine the DIEP harvest from a safety, expediency, and musculofascial preservation perspective, both for total mastectomy and partial mastectomy applications. Ultimately, a strategy based on the antegrade pedicle dissection technique, usually with a single perforator harvest and discontinuous fascial incisions, has lead to a safer, more expeditious and minimally invasive DIEP flap harvest that is applicable in many cases. Flap harvest time is now generally on the order of one hour with significantly less stress and minimized fascial incisions. DIEP free flap harvest can be managed with greater confidence, reduced operative times and less muscle, and fascial invasion using the specific operative strategy of the antegrade pedicle dissection technique. © 2009 Lippincott Williams & Wilkins, Inc.