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J Reconstr Microsurg
DOI: 10.1055/a-2355-3875
Original Article

Prophylactic Venous Supercharging in Deep Inferior Epigastric Artery Perforator Flap Surgery: A Retrospective Dual-Center Study

Giuseppe A.G. Lombardo 
1   Department of Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Catania, Italy
2   Università Unikore di Enna, Piazza dell'Università, Enna, EN, Italy
,
Mario Cherubino
3   Department of Plastic, Reconstructive and Aesthetic Surgery, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
,
Paolo Marchica
1   Department of Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Catania, Italy
,
Hillary Violini
1   Department of Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Catania, Italy
,
Domenico Marrella
1   Department of Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Catania, Italy
,
Francesco Ciancio
1   Department of Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Catania, Italy
,
Isidoro Musmarra
1   Department of Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Catania, Italy
,
Rosario Ranno
1   Department of Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Catania, Italy
,
Dario Melita
1   Department of Burn & Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliera Cannizzaro, Catania, Italy
› Author Affiliations Funding None.
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Abstract

Background Deep inferior epigastric artery perforator (DIEP) flap is nowadays considered the gold standard in breast reconstruction. However, venous congestion is still a leading cause of free flap failure. Despite the conspicuous articles regarding the use of a secondary venous anastomosis, there is a lack in the literature regarding the prophylactic use of a secondary venous route to reduce the incidence of complications during breast reconstruction.

Methods A double-center retrospective study based on women undergoing DIEP breast reconstruction was conducted, dividing patients into case group (DIEP flaps with double venous anastomosis) and control group (DIEP flaps with single venous anastomosis). Demographic and surgical data and complications were compared and statistically analyzed, and a reconstructive algorithm was proposed to improve the flap insetting.

Results In total, 154 patients were included in the study, divided into case group (74 patients) and control group (80 patients). The median age at the time of surgery was 49.09 years (range: 29–68 years), slightly lower in group 1 when compared with group 2. The mean body mass index (BMI) was 25.52 kg/m2 (range: 21.09–29.37 kg/m2), in particular 25.47 kg/m2 (range: 23.44–28.63 kg/m2) in group 1 and 25.58 kg/m2 (range: 21.09–29.37 kg/m2) in group 2. No statistical differences were found between groups in terms of BMI and smoking and comorbidities history. The average operative times were 272.16 minutes (range: 221–328 minutes) in group 1 and 272.34 minutes (range: 221–327 minutes) in group 2, with no significant difference between groups, as well as ischemia time (44.4 minutes in group 1 [range: 38–56 minutes] and 49.12 minutes in group 2 [range: 41–67 minutes]). Statistical analysis showed a reduction in short-term complications and a statistically significant reduction for take-backs in the two groups.

Conclusions Our study suggests that venous supercharging of DIEP flap by performing dual venous anastomosis can be routinely and safely done prophylactically, and thus not only after intraoperative assessment of venous congestion, to avoid flap venous congestion and decrease the rates of re-exploration.

Keywords

DIEP - DIEP flap - venous congestion - double vein - SIEV


Publication History

Received: 06 March 2024

Accepted: 22 June 2024

Accepted Manuscript online:
27 June 2024

Article published online:
15 July 2024

© 2024. Thieme. All rights reserved.

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