A Comparative Study Between Deep Inferior Epigastric Artery Perforator and Thoracoacromial Venous Supercharged Deep Inferior Epigastric Artery Perforator Flaps

Ayestaray, Benoît; Yonekura, Kairi; Motomura, Hisashi; Ziade, Makram

doi:10.1097/sap.0000000000000581

Cited by 24 publications

(48 citation statements)

References 29 publications

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“…Our review of the literature suggests that using the SIEV as flap vein for superdrainage is the best possible choice 1,15,[34][35][36][37]40 Also, if the etiology of the venous congestion is at least in part a lack of communication between the superficial and the deep systems, 41,42 choosing the SIEV to increase the venous drainage provided by the principal anastomosis (DIEV to IMV or to TDV/CSV) seems reasonable (►Fig. 5).…”

Section: Discussionmentioning

confidence: 97%

“…Several possibilities are available also when choosing the recipient vein for the superdrainage anastomosis. 1,34,36,40 While some authors prefer the intra-flap anastomosis (SIEV to DIEV) as discussed below, others 5,29-34,40,43 prefer,…”

Section: Discussionmentioning

confidence: 99%

“…as recipient vein, instead of the DIEV a vein of the chest so that the excessive venous output will be drained by an independent route, without the risk of engorging the flap's main pedicle. 31,32,43 In the literature, the only prospective and randomized study on the subject 40 reported a reduced venous congestion, and consequent necrosis of DIEP flaps when an adjunctive extra-flap anastomosis between the SIEV and the thoracoacromial vein was performed.…”

Section: Journal Of Reconstructive Microsurgerymentioning

confidence: 99%

“…Several authors also recommend the use of the superficial venous system supercharging as a preventive measure. 10,19,25,27,29,34,40,42,49,53 Many factors are involved in re-establishing a balance between arterial input and venous output in DIEP free flaps. Therefore a few proposals (among which six algorithms) to help in the choice of the veins to be used for the anastomosis have been published 1,15,[34][35][36][37] (►Tables 1 and 2).…”

Section: Journal Of Reconstructive Microsurgerymentioning

confidence: 99%

“…Performing an adjunctive anastomosis prolongs, the surgical procedure (up to 105 minutes as reported in the literature). 25,40 Choosing a vein of the chest as recipient adds to the procedure the time of vessel preparation, if not previously dissected (i.e., IMV or TDV).…”

Section: Journal Of Reconstructive Microsurgerymentioning

confidence: 99%

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Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature

Pignatti

Giorgini

Miralles

et al. 2020

J Reconstr Microsurg

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Background Venous congestion is the most common perfusion-related complication of deep inferior epigastric artery perforator (DIEP) flap. Several hydraulic constructs can be created for venous superdrainage in case of flap venous engorgement or as a preventive measure. These can be classified based on the choice of the draining vein of the flap, either a second deep inferior epigastric vein (DIEV) or a superficial inferior epigastric vein (SIEV), and of the recipient vein, either a vein of the chest or the DIEV. Methods We conducted a comprehensive systematic literature review in Medline, Scopus, EMBASE, Cochrane Library, and Google Scholar to find publications that reported on venous congestion in DIEP flap. The keywords used were DIEP Flap, breast reconstruction, venous congestion, supercharging, superdrainage, SIEV, and DIEV. Results Based on the studies found in the literature, we developed an algorithm to guide the surgeon's decision when choosing the veins for the superdrainage anastomosis. Conclusion Several alternatives for venous anastomosis in superdrainage are available. We propose an algorithm to simplify the choice. The use of the ipsilateral SIEV to be connected to a vein of the chest appears to be advantageous. The anatomical position that allows the easiest anastomosis dictates which chest vein to favor.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Journal Of Reconstructive Microsurgerymentioning

confidence: 99%

Section: Journal Of Reconstructive Microsurgerymentioning

confidence: 99%

Section: Journal Of Reconstructive Microsurgerymentioning

confidence: 99%

See 3 more Smart Citations

Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature

Pignatti

Giorgini

Miralles

et al. 2020

J Reconstr Microsurg

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Muscle‐splitting approach to thoracoacromial vein for superdrainage in deep inferior epigastric artery perforator flap breast reconstruction

2019

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Background Thoracoacromial vein (TAv) is seldomly considered as a secondary outflow recipient option when venous congestion of deep inferior epigastric artery perforator (DIEP) flap is encountered. The purpose of this study was to present a computed tomography (CT)‐based anatomy and a method of approaching TAv in performing superdrainage using superficial inferior epigastric vein (SIEV) in DIEP flap breast reconstruction. Methods For CT‐based anatomical study, 42 thoracoacromial vessels (TAV) of 21 patients who underwent DIEP flap breast reconstruction were analyzed. From November 2016 to May 2018, pectoralis major (PM) muscle splitting approach to TAv in the first intercostal space was applied to 7 patients who required superdrainage via SIEV. Results TAVs at mid‐first intercostal space (ICS) were located 83.5 ± 9.8 mm lateral to the sternal border (H), 41.5 ± 12.9 mm below the clavicle (V), and 11.7 ± 3.2 mm deep to the outer surface of PM muscle (D). Mean oblique distances from TAV to internal mammary vessels in the 2nd and 3rd ICS were 75.7 ± 9.7 mm and 98.2 ± 10.9 mm, respectively. Seven DIEP flaps presenting intraoperative venous congestion were successfully salvaged intraoperatively with superdrainge procedure. TAvs were harvested without cutting the PM muscle in any patient. Their mean size at anastomosis was 1.61 ± 3.2 mm (range, 0.9–2.5 mm). All flaps survived without perfusion‐related complications including fat necrosis. Conclusions Harvest of TAv by muscle‐splitting approach is an alternative option when additional venous anastomosis using SIEV is mandated for managing venous congestion of DIEP flap.

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Meta‐analysis of the effects of venous super‐drainage in deep inferior epigastric artery perforator flaps for breast reconstruction

et al. 2020

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Introduction: Venous congestion is the most common vascular complication of the deep inferior epigastric artery perforator (DIEP) flaps. Adding a second venous drainage by anastomosing a flap vein and a recipient vein (super-drainage) is considered the solution of choice. Evidence to support this procedure, had not yet been confirmed by an analysis of the literature. We aimed to provide this evidence. Materials and methods: We searched the literature (MedLine, Scopus, EMBASE, Cochrane Library, and Google Scholar), for studies discussing venous congestion and venous super-drainage in DIEP flap for breast reconstruction. Thirteen of the 35 articles compared results between one or two venous anastomoses. Meta-analysis was performed following PRISMA guidelines. Pooled risk ratio (RRs) for congestion, fat necrosis, partial necrosis, and total necrosis with corresponding 95% confidence intervals (CI) were calculated using a fixed-effect model with the Mantel-Haenszel method. The need to return to surgery (95% CI) was estimated with a random effect model using the DerSimonian and Liard method. Results: We showed a statistically significant advantage of super-drainage to reduce the venous congestion of the flap (RR: 0.12, 95% CI: 0.04-0.34, p-value <.001), partial flap necrosis (RR: 0.50, 95% CI: 0.30-0.84, p-value .008), total flap necrosis (RR: 0.31, 95% CI: 0.11-0.85, p-value .023), and the need to take the patient back to surgery for perfusion-related complications (RR: 0.45, 95% CI: 0.21-0.99, p value .048). Conclusions: Performing a second venous anastomosis between the SIEV and a recipient vein (venous superdrainage) reduces venous congestion and related complications in DIEP flaps for breast reconstruction.

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A Comparative Study Between Deep Inferior Epigastric Artery Perforator and Thoracoacromial Venous Supercharged Deep Inferior Epigastric Artery Perforator Flaps

Abstract: Thoracoacromial venous supercharging using the ipsilateral superficial inferior epigastric vein is a valuable method which considerably secures the DIEP free flap in breast reconstruction although it lengthens the operative procedure. EBM level: Level III.

Cited by 24 publications

References 29 publications

Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature

Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature

Muscle‐splitting approach to thoracoacromial vein for superdrainage in deep inferior epigastric artery perforator flap breast reconstruction

Meta‐analysis of the effects of venous super‐drainage in deep inferior epigastric artery perforator flaps for breast reconstruction

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