{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:10:22Z","timestamp":1789085422927,"version":"build-2803163510"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Abdominal wall bulges and hernias are not uncommon complications following deep inferior epigastric perforator (DIEP) flap harvest. Abdominal wall reinforcement using synthetic meshes has been found to decrease bulges by up to 70%; however, such meshes can be associated with other issues such as seromas and infections. Reinforced tissue matrix (RTM) mesh can be used for abdominal wall reinforcement due to its ability to recruit fibroblasts and provide a scaffold for cellular proliferation. There is no literature on the use of OviTex mesh for abdominal wall reinforcement following DIEP flap harvest. Therefore, this study aimed to evaluate the efficacy and safety of its use in this setting.<\/jats:p>\n                  <jats:p>A retrospective review was performed on patients undergoing DIEP flap harvest between January 2020 and June 2023. Patients who had completed at least 12 months of follow-up visits were included. Descriptive, univariate, and multiple logistic regression analyses were completed.<\/jats:p>\n                  <jats:p>A total of 199 patients were included. The mean age at the time of surgery was 51.1\u2009\u00b1\u200910.0 years and the mean body mass index (BMI) was 30.2\u2009\u00b1\u20095.9\u2009kg\/m2. Abdominal wall reinforcement was completed in 85 (42.7%) patients. Patients who had OviTex placed developed fewer bulges compared to the non-mesh cohort (0% vs. 5.3%, p\u2009=\u20090.04). Furthermore, OviTex mesh did not increase adverse events and was not significantly different in seroma\/hematoma rates when compared to the non-mesh cohort (10.6% vs. 5.3%, p\u2009=\u20090.26).<\/jats:p>\n                  <jats:p>This study demonstrates that OviTex mesh is safe and efficacious in reducing the rate of bulges following DIEP flap harvest without increasing other complications.<\/jats:p>","DOI":"10.1055\/a-2555-2348","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T21:01:46Z","timestamp":1741726906000},"page":"044-052","source":"Crossref","is-referenced-by-count":7,"title":["Abdominal Wall Reinforcement Using OviTex after Deep Inferior Epigastric Perforator Flap"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6840-9951","authenticated-orcid":false,"given":"Alec S.","family":"McCranie","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Blades","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Dawson","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose A.","family":"Foppiani","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Beth Isreal Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Allenby","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Winocour","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Cohen","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4388-1373","authenticated-orcid":false,"given":"David","family":"Mathes","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5631-8355","authenticated-orcid":false,"given":"Christodoulos","family":"Kaoutzanis","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1097\/PRS.0b013e3182a805a3","article-title":"Comprehensive analysis of donor-site morbidity in abdominally based free flap breast reconstruction","volume":"132","author":"E I Chang","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1080\/2000656X.2018.1498790","article-title":"Factors that predict deep inferior epigastric perforator flap donor site hernia and bulge","volume":"52","author":"D P Butler","year":"2018","journal-title":"J Plast Surg Hand Surg"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1016\/j.bjps.2020.12.044","article-title":"Abdominal weakness, bulge, or hernia after DIEP flaps: An algorithm of management, prevention, and surgical repair with classification","volume":"74","author":"N T Haddock","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"08","key":"ref4","doi-asserted-by":"crossref","first-page":"e481","DOI":"10.1097\/GOX.0000000000000439","article-title":"Lateral abdominal wall defects: The importance of anatomy and technique for a successful repair","volume":"3","author":"B J Pulikkottil","year":"2015","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"07","key":"ref5","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1054\/bjps.2000.3427","article-title":"A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap","volume":"53","author":"C M Futter","year":"2000","journal-title":"Br J Plast Surg"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1097\/01.prs.0000479931.96538.c5","article-title":"Surgically treated hernia following abdominally based autologous breast reconstruction: Prevalence, outcomes, and expenditures","volume":"137","author":"V Shubinets","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/PRS.0000000000001398","article-title":"Donor-site hernia repair in abdominal flap breast reconstruction: A population-based cohort study of 7929 patients","volume":"136","author":"J C Mennie","year":"2015","journal-title":"Plast Reconstr Surg"},{"issue":"11","key":"ref8","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/j.bjps.2017.05.044","article-title":"Donor site morbidity in DIEP free flap breast reconstructions: A comparison of unilateral, bilateral, and bipedicled surgical procedure types","volume":"70","author":"T Tomouk","year":"2017","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"07","key":"ref9","doi-asserted-by":"crossref","first-page":"e1405","DOI":"10.1097\/GOX.0000000000001405","article-title":"Donor-site morbidity after DIEAP flap breast reconstruction-A 2-year postoperative computed tomography comparison","volume":"5","author":"C A Ingvaldsen","year":"2017","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1097\/PRS.0000000000003843","article-title":"Clinical and quantitative isokinetic comparison of abdominal morbidity and dynamics following DIEP versus muscle-sparing free TRAM flap breast reconstruction","volume":"140","author":"H Uda","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"ref11","doi-asserted-by":"crossref","first-page":"3683","DOI":"10.1016\/j.bjps.2022.06.017","article-title":"Prevention and management of post-deep inferior epigastric perforator flap abdominal bulge: A 5-year single-surgeon series","volume":"75","author":"M Jakeman","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1007\/s00266-020-02096-0","article-title":"The use of semi-absorbable mesh and its impact on donor-site morbidity and patient-reported outcomes in DIEP flap breast reconstruction","volume":"45","author":"L C Siegwart","year":"2021","journal-title":"Aesthetic Plast Surg"},{"issue":"01","key":"ref13","first-page":"e34156","article-title":"Onlay versus sublay mesh repair for incisional hernias: A systematic review","volume":"15","author":"C Pereira","year":"2023","journal-title":"Cureus"},{"issue":"11","key":"ref14","doi-asserted-by":"crossref","first-page":"2389","DOI":"10.1007\/s00268-011-1266-5","article-title":"Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies","volume":"35","author":"M N Mavros","year":"2011","journal-title":"World J 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(Basel)"},{"issue":"9596","key":"ref18","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"E von Elm","year":"2007","journal-title":"Lancet"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1055\/s-0036-1586495","article-title":"Reducing postoperative abdominal bulge following deep inferior epigastric perforator flap breast reconstruction with Onlay monofilament poly-4-hydroxybutyrate biosynthetic mesh","volume":"33","author":"B A Wormer","year":"2017","journal-title":"J Reconstr Microsurg"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jss.2016.09.055","article-title":"Mesh reinforcement for the prevention of incisional hernia formation: a systematic review and meta-analysis of randomized controlled 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Microsurg"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1055\/a-2071-3368","article-title":"A machine learning approach to predicting donor site complications following DIEP flap harvest","volume":"40","author":"H Huang","year":"2024","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref30","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1590\/S0102-86502014000200008","article-title":"Alloxan diabetes alters the tensile strength, morphological and morphometric parameters of abdominal wall healing in rats","volume":"29","author":"J G Minossi","year":"2014","journal-title":"Acta Cir Bras"},{"issue":"03","key":"ref31","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1055\/a-2133-1018","article-title":"Operative time predicts long-term abdominal morbidity and complication requiring treatment after DIEP flap breast reconstruction","volume":"40","author":"Y E Wen","year":"2024","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref32","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1055\/s-0042-1744310","article-title":"Characterizing outcomes of medial and lateral perforators in deep inferior epigastric perforator flaps","volume":"39","author":"A A Elver","year":"2023","journal-title":"J Reconstr Microsurg"},{"issue":"06","key":"ref33","doi-asserted-by":"crossref","first-page":"2198","DOI":"10.1097\/PRS.0b013e3182131caf","article-title":"Abdominal donor-site outcomes for medial versus lateral deep inferior epigastric artery branch perforator harvest","volume":"127","author":"P B Garvey","year":"2011","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1097\/PRS.0000000000004631","article-title":"Optimizing perforator selection: A multivariable analysis of predictors for fat necrosis and abdominal morbidity in DIEP flap breast reconstruction","volume":"142","author":"A Hembd","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"ref35","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1111\/tbj.14003","article-title":"Donor site aesthetics and morbidity after DIEP flap breast reconstruction-A retrospective multicenter study","volume":"26","author":"L Gr\u00fcnherz","year":"2020","journal-title":"Breast J"},{"issue":"06","key":"ref36","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1097\/01.prs.0000210679.77449.7d","article-title":"DIEP and pedicled TRAM flaps: a comparison of outcomes","volume":"117","author":"P B Garvey","year":"2006","journal-title":"Plast Reconstr Surg"}],"container-title":["Journal of Reconstructive 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