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

Abstract

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.