Anatomical features associated with venous congestion in DIEP flap using CT angiography with three-dimensional reconstruction

Ruiz-Moya, Alejandro; Lopez-Garcia, Rafael-Antonio; Sicilia-Castro, Domingo; Gómez-Cía, Tomás; Infante-Cossio, Pedro

doi:10.20517/2347-9264.2017.29

Cited by 6 publications

(7 citation statements)

References 26 publications

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“…However, there are contrasting opinions that the SIEV diameter may not be an absolute predictor of venous congestion. Some recent studies have shown no direct correlation between vessel diameters in the super cial and deep inferior epigastric systems and venous congestion [42][43][44]. In the current study, the diameter of the SIEV on both sides did not show any correlation with venous congestion.…”

Section: Discussioncontrasting

confidence: 76%

Efficacy of superficial inferior epigastric vein superdrainage in TRAM and DIEP flap: An Indocyaning green angiography study of 68 cases

Zhu

Yoo

Min

et al. 2023

Preprint

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This study aimed to evaluate the efficacy of venous augmentation using superficial inferior epigastric vein (SIEV) in transverse rectus abdominis musculocutaneous (TRAM) and deep inferior epigastric artery perforator (DIEP) flap. A retrospective review was performed of 62 free TRAM and 6 DIEP unilateral breast reconstructions from September 2017 to July 2022. Intraoperative indocyanine green angiography was performed with the SIEV contralateral to the pedicle clamped and declamped for 20 min. The ratio of hypoperfused area was calculated and compared quantitatively. The preoperative computed tomography angiography was reviewed to measure the SIEV diameter and number of midline-crossing medial branches. Sixty-two percent (42/68 cases) resulted in perfusion improvement after SIEV superdrainage (Group 1), whereas 29.4 percent (20/68 cases) resulted in sustained (Group 2) and 8.8 percent (6/68 cases) in aggravated perfusion (Group3). The mean number of midline-crossing branches (p = 0.002) and mean difference in the diameter of bilateral SIEVs (p = 0.039) were significantly greater in Group 1 compared to the other groups. Superdrainage using the contralateral SIEV in TRAM/DIEP flap is recommended when there are more than 2 midline-crossing medial branches of SIEV and when the caliber of draining vein is greater than that of the pedicle side.

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Section: Discussioncontrasting

confidence: 76%

Efficacy of superficial inferior epigastric vein superdrainage in TRAM and DIEP flap: An Indocyaning green angiography study of 68 cases

Zhu

Yoo

Min

et al. 2023

Preprint

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“…In Ruiz-Moya A et al's literature, the team believe that if CT angiography (CTA) can be (3D) virtual reconstruction, it will be better used for breast planning and reconstruction of deep inferior epigastric artery perforator (DIEP). Although the operation is likely to produce diffuse venous congestion, scientists have not found its mechanism [ 3 ]. In Mou et al's research, the team collected relevant information by investigating patients, through literature review, consulting professionals, organizing case discussion, consulting relevant literature, and establishing the damage assessment model according to relevant data.…”

Section: Introductionmentioning

confidence: 99%

The Role of Three-Dimensional Reconstruction of Medical Images and Virtual Reality in Nursing Experimental Teaching

Zhu

Zhao

et al. 2022

Journal of Healthcare Engineering

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With the continuous advancement of medicine and computer science, medical image processing technology is also constantly advancing, and at the same time, it puts forward the needs of its own development. The purpose of this article is to combine the three-dimensional reconstruction of medical images and virtual reality (VR) technology in nursing experiment teaching to help students understand more easily and to simplify the teachers’ teaching process and make the VR application technology. It is the most popular and effective in medical teaching. This article proposes the C-V model and the geometric active contour model to help us more clearly understand the pathology in this environment, where the specific symptoms appear, and bring a more easy-to-understand model for teaching and improving teaching quality. This article also designs nursing experiment teaching. The experimental results of this paper show that, after using VR courseware for teaching, the optimal test rate of the experimental class is 15% higher than that of the control class, and the transition rate is 8%. The actual test excellent rate and success rate of the experimental class are much higher than those of the control class. Therefore, it can be concluded that the application of VR technology in nursing teaching helps teachers improve their practical ability. The excellent teaching feedback rate is 95%, which is higher than 80.5% in the control group, indicating that the patient teaching simulation is approved by the observation group. The program can effectively improve the feedback rate of excellent teaching and provide students with better teaching services.

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“…The deep inferior epigastric artery perforator (DIEAP) flap was first described by Koshima and Soeda in 1989 [1]. In 1994, Allen and Treece demonstrated the applicability of the DIEAP flap in breast reconstruction [2], which is currently assumed as the gold standard for autologous breast reconstruction [3,4]. This technique significantly decreased the abdominal wall complication rate when compared to the transverse rectus abdominis myocutaneous (TRAM) flap [3,5].…”

Section: Introductionmentioning

confidence: 99%

“…The superficial and deep venous systems are connected through some communicating veins that allow free blood flow between each system [11,12]. During the dissection of the DIEAP flap, the SIEV is ligated, redirecting the venous blood through the communicating veins to the deep inferior epigastric venae (DIEV) comitantes, via the venae comitantes of the selected paraumbilical perforator [4,6,8,10,[12][13][14]. In the end, the flap's venous outflow is granted by two DIEV comitantes that communicate with each other and run in close relation with the DIEA [14].…”

Section: Introductionmentioning

confidence: 99%

A Systematic Approach to Intraoperative Venous Congestion in the Deep Inferior Epigastric Artery Perforator (DIEAP) Flap

João,

Eiró,

Nogueira

et al. 2023

Cureus

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The deep Inferior epigastric artery perforator (DIEAP) flap is currently the gold standard for autologous breast reconstruction. This flap is susceptible to venous congestion, which can result in partial or complete flap loss. Apart from external causes, venous congestion may be caused by the flap's vascular architecture, either due to a dominance of the superficial venous system or due to impaired communication between the superficial and deep venous systems. This inefficient vascular architecture can be detected during surgery, and the venous outflow drainage can be improved through several techniques. We present two case reports of intraoperative venous congestion. In the first case, we performed an intra-flap rerouting, through a venous anastomosis between the superficial and the deep venous systems. In the second case, an extra-flap rerouting was executed, through a venous anastomosis between the superficial venous system and a recipient vein. We present the current institutional approach to DIEAP flap breast reconstruction, incorporating surgical insights for addressing intraoperative venous congestion.

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Anatomical features associated with venous congestion in DIEP flap using CT angiography with three-dimensional reconstruction

Cited by 6 publications

References 26 publications

Efficacy of superficial inferior epigastric vein superdrainage in TRAM and DIEP flap: An Indocyaning green angiography study of 68 cases

Efficacy of superficial inferior epigastric vein superdrainage in TRAM and DIEP flap: An Indocyaning green angiography study of 68 cases

The Role of Three-Dimensional Reconstruction of Medical Images and Virtual Reality in Nursing Experimental Teaching

A Systematic Approach to Intraoperative Venous Congestion in the Deep Inferior Epigastric Artery Perforator (DIEAP) Flap

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