Deep inferior epigastric perforator flap breast reconstruction in patients with Raynaud's disease: a case series and literature review.

Free tissue transfer using the deep inferior epigastric perforator (DIEP) flap represents the gold-standard for autologous breast reconstruction. Raynaud's disease, characterized by vasospasm, thrombosis, and a hypercoagulable state, poses a theoretical risk to flap viability; however, its impact on DIEP outcomes remains poorly defined. We present the first reported case series evaluating DIEP flap reconstruction in three patients with Raynaud's disease. In the first case, complete flap loss occurred due to thrombosis, in the absence of vasoprotective strategies. The subsequent two patients received intraoperative papaverine and verapamil to mitigate vasospasm, and postoperative antiplatelet therapy with aspirin and dipyridamole. Both achieved successful flap outcomes without microvascular complications. Our findings suggest Raynaud's disease should not be considered a contraindication to DIEP flap reconstruction, provided tailored perioperative pharmacological strategies are employed. Larger studies are warranted to evaluate outcomes and guide evidence-based perioperative protocols in this understudied patient population.