A single center comparison of one versus two venous anastomoses in 564 consecutive DIEP flaps: Investigating the effect on venous congestion and flap survival

Abstract

The use of a secondary vein in the drainage of a DIEP flap can significantly reduce the incidence of venous congestion, with no detriment to complication rates. Consideration of incorporating both the superficial and deep venous systems is an approach that may further improve the venous drainage of the flap.

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

“…Accordingly, there is a significant degree of variability in the diameters available for anastomosis at the fifth ICS (1.0-3.9 mm), creating a degree of uncertainty regarding the availability of adequate venous drainage at that level [83]. This is an understandable concern to surgeons as venous congestion is a major cause of flap failure, complicating up to 10% of conventional DIEP reconstructions with up to 5% requiring reoperation [84][85][86][87]. Fortunately, the majority of IMVs at this level are of suitable calibre (1.7-2.5 mm) and can be accurately assessed through radiological means.…”

Double Venous System Drainage in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

“…The rapid availability of "in house" physicians and residents and the large volume of procedures performed in these settings contribute to excellent outcomes at many facilities [2][3][4][5][6][7]13,16].With some exceptions, community-based hospitals tend not to be equipped for rapid return to the operating room should vascular complications arise. In these instances, referring physicians may then be more encouraged to refer to plastic surgeons who perform procedures with fewer short-term complications even if their long-term reconstructive outcomes are less optimal.…”

“…[2] Other large series have reported similar results with respect to major complications. [2][3][4][5][6][7]13,16] With regards to vascular problems, venous congestion tends to be the primary concern for microsurgeons who perform DIEP flap breast reconstruction. Complications due to the venous drainage or venous anastomosis have been shown to be eight times more common than issues arising from arterial insufficiency or arterial anastomotic complications.…”

“…[3][4][5][6][7] Anatomic studies have shown that the deep inferior epigastric vein (DIEV) connects with the superficial inferior epigastric vein (SIEV) through a system of choke vessels within the flap. [8] In numerous studies, the superficial venous system has been used to adequately decongest the flap in cases where venous congestion was clinically observed [9][10][11][12][13]. We have found that routinely anastomosing both the superficial and deep venous systems has resulted in significantly fewer operative take-backs and decreased venous complications with use of the DIEP flap.…”

Novel use of the superficial inferior epigastric vein lifeboat in DIEP flap harvest

“…In such cases, flap salvage may require establishment of a secondary venous outflow source. Some authors utilize a secondary venous outflow source as a primary manoeuvre, while others use a Bwait-and-see^approach, rather than prophylactically performing a secondary venous outflow, given that venous congestion occurs in less than 5-10 % of cases (the approach that we employ) [1][2][3][4][5].…”