Umbilical Ablation During Abdominal Flap Harvest Decreases Donor Site Complications

Purpose: Donor site complications are a significant source of morbidity for patients undergoing deep inferior epigastric artery perforator (DIEP) flap reconstruction. Most studies have focused on post-operative hernias and bulges; however, there is a paucity of data regarding minimizing post-operative wound healing and infection rates. We hypothesize that ablation of the umbilicus at the time of DIEP harvest decreases the incidence of umbilical and abdominal wall complications by avoiding additional skin flap undermining and incisions.

Methods: A retrospective review was performed of all (119) patients who underwent DIEP harvest with concomitant umbilical ablation and subsequent umbilicoplasty from 2010-15. Umbilicoplasty was performed at the time of revision or nipple reconstruction by using a local flap and full-thickness skin graft to create an aesthetically pleasing neo-umbilicus. This cohort was paired with 119 patients who underwent DIEP harvest without umbilical ablation. Pre-operative risk factors, intra-operative factors, and post-operative complications were compared.

Results: The umbilical ablation group had significantly higher BMI (30.9 vs 27.4, p=<.001), presence of umbilical scar (20.9% vs 5.3%, p=<.001), umbilical hernia (82.9% vs 8.5% p=<.001), ventral hernia (23.9% vs 1.7%, p=<.001), and rectus diastasis (10.3% vs 2.6%, p=0.016). There were no significant differences in incidence of smoking, diabetes mellitus, hypertension, prior abdominal scar, or midline abdominal scar. The umbilical ablation group had a significantly lower rate of post-operative abdominal wound dehiscence and skin loss (11.1% vs 22.2%, p=0.023) and overall donor site complication rate (24.8% vs 39.3%, p=0.017). There was no significant difference in incidence of partial-thickness skin loss, cellulitis, seroma, or abscess. Mean follow-up time was 1.8 years.

Conclusions: These data reveal that umbilical ablation significantly decreases the incidence of complications, including abdominal dehiscence and skin loss, even in the setting of increased risk factors for poor wound healing. This decreased incidence of abdominal complications is likely due to avoidance of umbilical incisions and decreased abdominal skin flap undermining, both resulting in less interruption of skin blood supply. We conclude that umbilical ablation is a viable option to minimize donor site complications and may be especially useful in high-risk patients.