Are Pfannenstiel Scars a Boon or a Curse for DIEP Flap Breast Reconstructions?
Bibliographic record
Abstract
BACKGROUND: Abdominal incisions and their subsequent scarring alter the vascular architecture of the abdominal pannus. This is of significance when reconstructing the breast with the deep inferior epigastric perforator (DIEP) flap. This study aimed to objectively investigate the impact of the lower abdominal Pfannenstiel scar in utilizing the DIEP flap. METHODS: A retrospective study of breast reconstruction with DIEP flaps was conducted on patients who had a Pfannenstiel scar (n = 36) compared with patients who did not (n = 36). Computed tomography angiograms were analyzed for the numbers, positions, and dimensions of perforator vessels. Influence of the scar on the reconstructive outcome was assessed. RESULTS: The number of perforators was greater in the control group (mean, 9.14) compared with the study group (mean, 8.3) but was not significant, with marginal significance (p = 0.09). The percentage of found perforators with 4 mm or greater was significantly higher in the study group than in the control group (21.7 percent compared with 14.3 percent, respectively; p = 0.04). The position of perforators was more or less the same, and complications were also comparable in both groups. CONCLUSIONS: Pfannenstiel incisions result in undermining of the lower abdominal apron and, in most cases, division of the superficial epigastric vessels. This results in "ischemic preconditioning" of the flap, as has been evidenced by the increased dimensions of the perforators. Hence, flaps raised from these abdomens are not only safe but may even be better vascularized. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".