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J Reconstr Microsurg 2012; 28(05): 313-318
DOI: 10.1055/s-0032-1311688
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Augmentation of Venous Drainage in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Efficacy and Advancement

Qiang Xin
1   Breast Center, Plastic Surgery Hospital, Beijing, China
,
Jie Luan
1   Breast Center, Plastic Surgery Hospital, Beijing, China
,
Hua Mu
1   Breast Center, Plastic Surgery Hospital, Beijing, China
,
Li Mu
1   Breast Center, Plastic Surgery Hospital, Beijing, China
› Author Affiliations
Further Information

Publication History

26 August 2011

22 December 2011

Publication Date:
19 April 2012 (online)

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Abstract

Deep inferior epigastric perforator flap (DIEP) is the workhorse for autologous breast reconstruction because it is associated with less abdominal wall donor site morbidity; however, the high incidence of venous congestion of zone IV within the DIEP flap is the most important disadvantage. Venous augmentation may be an appropriate method for venous decompression of the DIEP flap. This study aims to assess retrospectively the efficacy of the venous augmented DIEP flap and to present an advanced technique for venous augmentation. A total of 79 breast reconstructions using DIEP flap from January 2006 to March 2011 were included. Thirty-two patients who underwent venous augmented DIEP flap were selected as the test group, and 47 patients who underwent the traditional DIEP flap were included as the control group. Three indices—operation time, flap size, and flap complication rate—were compared between the two groups. The operation time was 6.6 ± 0.7 hours in the test group and 6.1 ± 1.2 hours in the control group (p < 0.05). The mean flap size was 325.9 ± 20.6 cm2 in the test group and 294.7 ± 24.2 cm2 in the control group (p <0.05). In the test group, there was one partial flap loss (complication rate was 3.1%). In the control group, the total complication rate was 10.6% (p <0.05). Venous augmentation can successfully enhance the viability of a DIEP flap. The SIEV-SIEV (superficial inferior epigastric vein) reverse-flow anastomosis is an efficient and convenient method of venous augmentation for DIEP flap, with negligible drawbacks.

Keywords

breast reconstruction - DIEP - venous augmentation - flap congestion
 

  • References

  • 1 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32: 32-38
    Search in Google Scholar
  • 2 Blondeel PN, Boeckx WD. Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery. Br J Plast Surg 1994; 47: 495-501
    Search in Google Scholar
  • 3 Hamdi M, Weiler-Mithoff EM, Webster MHC. Deep inferior epigastric perforator flap in breast reconstruction: experience with the first 50 flaps. Plast Reconstr Surg 1999; 103: 86-95
    CrossrefPubMedSearch in Google Scholar
  • 4 Tutor EG, Auba C, Benito A, Rábago G, Kreutler W. Easy venous superdrainage in DIEP flap breast reconstruction through the intercostal branch. J Reconstr Microsurg 2002; 18: 595-598
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 1999; 52: 104-111
    CrossrefPubMedSearch in Google Scholar
  • 6 Blondeel PN, Arnstein M, Verstraete K , et al. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 2000; 106: 1295-1299
    CrossrefPubMedSearch in Google Scholar
  • 7 Wechselberger G, Schoeller T, Bauer T, Ninkovic M, Otto A, Ninkovic M. Venous superdrainage in deep inferior epigastric perforator flap breast reconstruction. Plast Reconstr Surg 2001; 108: 162-166
    CrossrefPubMedSearch in Google Scholar
  • 8 Blondeel PN, Van Landuyt KH, Monstrey SJ. Surgical-technical aspects of the free DIEP flap for breast reconstruction. Oper Tech Plast Reconstr Surg 1999; 6: 27-37
    CrossrefPubMedSearch in Google Scholar
  • 9 Kroll SS. Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 2000; 106: 576-583
    CrossrefPubMedSearch in Google Scholar
  • 10 Villafane O, Gahankari D, Webster M. Superficial inferior epigastric vein (SIEV): 'lifeboat' for DIEP/TRAM flaps. Br J Plast Surg 1999; 52: 599-600
    PubMedSearch in Google Scholar
  • 11 Tran NV, Buchel EW, Convery PA. Microvascular complications of DIEP flaps. Plast Reconstr Surg 2007; 119: 1397-1405 ; discussion 1406–1408
    CrossrefPubMedSearch in Google Scholar
  • 12 Hallock GG, Rice DC. Efficacy of venous supercharging of the deep inferior epigastric perforator flap in a rat model. Plast Reconstr Surg 2005; 116: 551-555 ; discussion 556
    CrossrefPubMedSearch in Google Scholar
  • 13 Schaverien M, Saint-Cyr M, Arbique G, Brown SA. Arterial and venous anatomies of the deep inferior epigastric perforator and superficial inferior epigastric artery flaps. Plast Reconstr Surg 2008; 121: 1909-1919
    CrossrefPubMedSearch in Google Scholar
  • 14 Carramenha e Costa MA, Carriquiry C, Vasconez LO, Grotting JC, Herrera RH, Windle BH. An anatomic study of the venous drainage of the transverse rectus abdominis musculocutaneous flap. Plast Reconstr Surg 1987; 79: 208-217
    CrossrefPubMedSearch in Google Scholar
  • 15 Blondeel PN. Venous augmentation of the free TRAM flap. Br J Plast Surg 2002; 55: 87
    PubMedSearch in Google Scholar
  • 16 Lee JW, Lee YC, Chang TW. Microvascularly augmented transverse rectus abdominis myocutaneous flap for breast reconstruction—reappraisal of its value through clinical outcome assessment and intraoperative blood gas analysis. Microsurgery 2008; 28: 656-662
    CrossrefPubMedSearch in Google Scholar
  • 17 Niranjan NS, Khandwala AR, Mackenzie DM. Venous augmentation of the free TRAM flap. Br J Plast Surg 2001; 54: 335-337
    CrossrefPubMedSearch in Google Scholar
  • 18 Cohn AB, Walton RL. Immediate autologous breast reconstruction using muscle-sparing TRAM flaps with superficial epigastric system turbocharging: a salvage option. J Reconstr Microsurg 2006; 22: 153-156
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Rohde C, Keller A. Novel technique for venous augmentation in a free deep inferior epigastric perforator flap. Ann Plast Surg 2005; 55: 528-530
    CrossrefPubMedSearch in Google Scholar
  • 20 Liu TS, Ashjian P, Festekjian J. Salvage of congested deep inferior epigastric perforator flap with a reverse flow venous anastomosis. Ann Plast Surg 2007; 59: 214-217
    CrossrefPubMedSearch in Google Scholar
  • 21 Nakajima H, Imanishi N, Aiso S, Fujino T. Venous drainage of the radial forearm and anterior tibial reverse flow flaps: anatomical and radiographic perfusion studies. Br J Plast Surg 1997; 50: 389-401
    CrossrefPubMedSearch in Google Scholar
  • 22 van Bemmelen PS, Beach K, Bedford G, Strandness Jr DE. The mechanism of venous valve closure. Its relationship to the velocity of reverse flow. Arch Surg 1990; 125: 617-619
    CrossrefPubMedSearch in Google Scholar
  • 23 Keller A. The deep inferior epigastric perforator free flap for breast reconstruction. Ann Plast Surg 2001; 46: 474-479 ; discussion 479–480
    CrossrefPubMedSearch in Google Scholar
  • 24 Holm C, Mayr M, Höfter E, Ninkovic M. Perfusion zones of the DIEP flap revisited: a clinical study. Plast Reconstr Surg 2006; 117: 37-43
    CrossrefPubMedSearch in Google Scholar