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In a review of the charts of 158 patients who had undergone breast reconstruction with free transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps and who were treated for postoperative pain with morphine administered by a patient-controlled analgesia pump, the total dose of morphine administered during hospitalization for the flap transfer was measured. Patients whose treatment was supplemented by other intravenous narcotics were excluded from the study. The mean amount of morphine per kilogram required by patients who had reconstruction with DIEP flaps (0.74 mg/kg, n 26) was found to be significantly less than the amount required by patients who had reconstruction with TRAM flaps (1.65 mg/kg; n 132; p 0.001). DIEP flap patients also remained in the hospital less time (mean, 4.73 days) than did free TRAM flap patients (mean, 5.21 days; p 0.026), but the difference was less than one full hospital day. It was concluded that the use of the DIEP flap does reduce the patient requirement for postoperative pain medication and therefore presumably reduces postoperative pain. It may also slightly shorten hospital stay.(Plast. Reconstr. Surg. 107: 338, 2001.)

The deep inferior epigastric perforator (DIEP) flap1–5 is a relatively new modification of the free transverse rectus abdominis musculocutaneous (TRAM) flap in which branches of the deep inferior epigastric artery and vein are dissected out of the rectus abdominis muscle so that only blood vessels, and no muscle, are harvested with the flap (Figs. 1 and 2). In this way, donor-site morbidity is minimized and postoperative pain is reduced …