The Superficial Vein Only (SVO)-DIEP Flap

Abstract

Background: The deep inferior epigastric artery perforator (DIEP) flap, often considered the standard in autologous breast reconstruction, is reliant on robust arterial inflow and venous outflow. Venous outflow issues remain a critical part in determining the success of the DIEP flap. Previously, the superficial inferior epigastric vein (SIEV) has been used to augment venous outflow, or as a salvage option when flow through the deep inferior epigastric vein is compromised or insufficient. The authors describe a variant of the DIEP flap, the superficial vein–only DIEP flap, using the deep inferior epigastric artery and the SIEV as a viable alternative when indicated. Methods: The authors conducted a retrospective review of all patients undergoing autologous breast reconstruction performed by the senior author (B.C.) from July of 2015 to March of 2020 to identify DIEP flaps whose only source of venous outflow was the SIEV, excluding those performed as salvage maneuvers. Results: The authors identified 30 patients (35 flaps) and describe their characteristics, flap characteristics, complications, and details of the flap harvest. Notably, the authors experienced complications in 26.7 percent of flaps, of which 62.5 percent were minor, with no flap loss. This was comparable to the complication rate observed in the standard DIEP flap population. Conclusions: The authors believe the superficial vein–only DIEP flap is an excellent option for the appropriate patient. It is an added tool to make abdominally based breast reconstruction more reliable and successful. The use of the SIEV in a superficial vein–only flap should be considered as part of any routine DIEP flap reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap

“…The use of a cannula to intermittent superdischarge the flap through the SIEV ( 9 , 10 , 79 ) as well as the use of SIEV alone in a setting of absent drainage via the DIEV ( 7 ) or by given evidence of sufficient venous outflow ( 80 ) are also described in the literature. The use of a “superficial vein-only” DIEP flap in cases of venous congestion and when the perforator veins were deemed much smaller than the SIEV was also described recently ( 81 ).…”

The Superficial Vein–Only DIEP Flap

“…We read with interest this retrospective investigation by Nigro et al, 1 although we find that the conclusion is insufficiently supported. While discussing the results, the authors mention that “these values are not significantly different”; they refer to a statistical analysis by means of the t test, but do not present any P values.…”

Reply: The Superficial Vein–Only DIEP Flap

“…We would like to thank you for the critical analysis of our recent article “The Superficial Vein−Only DIEP Flap.” 1 The purpose of this article was to share our experience with a variation of the deep inferior epigastric artery perforator (DIEP) flap in which the superficial inferior epigastric vein (SIEV) can safely provide the only source of venous outflow. The viability of the superficial vein−only (SVO) DIEP flap has been suggested by anatomical studies, and this correlates clinically with our results.…”