Endoscopic drainage for the management of infected subcutaneous collections following diep flap reconstruction technique: a case report

Abstract Aim The deep inferior epigastric perforator (DIEP) flap procedure is a widely accepted method for immediate breast reconstruction following skin-sparing mastectomy in breast cancer patients. While complications are infrequent, challenges may arise, including surgical wound infection, skin necrosis, seroma, or hematoma. Methods We present the case of a 68-year-old woman with multifocal infiltrating carcinoma of the right breast (T1cN0M0) who underwent DIEP flap breast reconstruction one month before presenting to the emergency room. Her symptoms included a fever of 38°C, abdominal filling in the DIEP scar region, an elevated leukocyte count (23.01 × 10E3/microL), and a C-reactive protein level of 470 mg/L. Abdominal CT revealed a collection in the infraumbilical anterior abdominal wall extending through the subcutaneous cellular tissue of both iliac fossae. The patient underwent surgical intervention, including endoscopic drainage with lavage and drain placement under direct visualization. Results Following surgery, the patient responded positively to intravenous Meropenem, with the resolution of fever and improvement in local cellulitis. She was discharged on the 6th postoperative day with both drains, removed 10 and 15 days after surgery in an outpatient setting. Conclusions In cases where immediate percutaneous drainage is not feasible, endoscopic drainage emerges as an effective strategy for managing extensive infectious collections. This technique, involving lavage, debridement, and drain placement under direct vision, eliminates the need to reopen substantial surgical wounds. Notably, this approach aids early recovery in patients undergoing active chemotherapy, preventing delays in chemotherapy administration.