{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T04:53:54Z","timestamp":1774414434096,"version":"3.50.1"},"reference-count":18,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The deep inferior epigastric artery perforator (DIEP) flap is currently the most widely used method for autologous breast reconstruction. Its primary advantage over the transverse rectus abdominis muscle (TRAM) flap is the reduction in donor-site morbidity, as it preserves the integrity of the abdominal muscles and motor nerves. Importantly, each patient\u2019s unique vascular anatomy requires an individualized approach to perforator selection and the surgical technique. Objective: We aimed to minimize donor-site morbidity and refine the perforator selection strategy in delayed DIEP flap breast reconstruction using the abdominal perforator exchange (APEX) technique. Materials and Methods: In this study, we prospectively and retrospectively analyzed the use of the APEX technique in patients undergoing delayed DIEP flap breast reconstruction between April 2020 and October 2024. All patients underwent preoperative non-contrast magnetic resonance angiography of the donor area. A total of 106 patients were enrolled and divided into two groups: 34 patients underwent reconstruction using the APEX technique, and 72 patients received standard DIEP flap breast reconstruction. Results: Our study demonstrated a statistically significant increase in operative time, averaging 30.5 min in the APEX group (p &lt; 0.05). There was also a significant difference in the incidence of marginal flap necrosis between the two groups. No cases of myotomy were observed, and motor nerve transection was required in one case. Conclusions: The APEX technique has been shown to be reliable when standard dissection would compromise the neuromuscular anatomy of the abdominal wall without compromising perfusion in the flap.<\/jats:p>","DOI":"10.3390\/jcm14093256","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T11:46:19Z","timestamp":1746618379000},"page":"3256","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Role of the Abdominal Perforator Exchange (APEX) Technique in the Perforator Selection Algorithm for Delayed Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction"],"prefix":"10.3390","volume":"14","author":[{"given":"Dmitry V.","family":"Melnikov","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia"},{"name":"Department of Reconstructive and Plastic Surgery, Lancet Clinic, 105066 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0283-5370","authenticated-orcid":false,"given":"Elina I.","family":"Abdeeva","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Semyon I.","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia"},{"name":"Department of Reconstructive and Plastic Surgery, Lancet Clinic, 105066 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor A.","family":"Gombolevskiy","sequence":"additional","affiliation":[{"name":"Institute for Personalized Oncology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia"},{"name":"Artificial Intelligence Research Institute (AIRI), 121170 Moscow, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1224e","DOI":"10.1097\/PRS.0000000000003336","article-title":"Comparing Health Care Resource Use between Implant and Autologous Reconstruction of the Irradiated Breast: A National Claims-Based Assessment","volume":"139","author":"Aliu","year":"2017","journal-title":"Plast. Reconstr. 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Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e3120","DOI":"10.1097\/GOX.0000000000003120","article-title":"Complications and Patient-reported Outcomes after TRAM and DIEP Flaps: A Sys-tematic Review and Meta-analysis","volume":"8","author":"He","year":"2020","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_6","first-page":"7857158","article-title":"Morbidity of the Donor Site and Complication Rates of Breast Reconstruction with Autologous Abdominal Flaps: A Systematic Review and Meta-Analysis","volume":"136","author":"Mortada","year":"2022","journal-title":"Breast J."},{"key":"ref_7","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":"Mennie","year":"2015","journal-title":"Plast. Reconstr. 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Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e6392","DOI":"10.1097\/GOX.0000000000006392","article-title":"Approach to DIEP Flap Pedicle Dissection via a Midline Fascial Incision","volume":"12","author":"Gowda","year":"2024","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/PRS.0000000000003413","article-title":"Medial Row Perforators Are Associated with Higher Rates of Fat Necrosis in Bilateral DIEP Flap Breast Reconstruction","volume":"140","author":"Kamali","year":"2017","journal-title":"Plast. Reconstr. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/3256\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:28:52Z","timestamp":1760030932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/3256"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,7]]},"references-count":18,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14093256"],"URL":"https:\/\/doi.org\/10.3390\/jcm14093256","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,7]]}}}