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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(04): 482-487
DOI: 10.1055/s-0042-1748645
Breast/Trunk
Review Article

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap

Seong Oh Park 
1   Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea
,
Nobuaki Imanishi 
2   Department of Anatomy, Keio University College of Medicine, Tokyo, Japan
,
Hak Chang 
3   Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract

In lower abdominal flap representing transverse rectus abdominis musculocutaneous (TRAM) flap or deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric vein (SIEV) exists as superficial and independent venous system from deep system. The superficial venous drainage is dominant despite a dominant deep arterial supply in anterior abdominal wall. As TRAM or DIEP flaps began to be widely used for breast reconstruction, venous congestion issue has been arisen. Many clinical series in regard to venous congestion despite patent microvascular anastomosis site were reported. Venous congestion could be divided in two conditions by the area of venous congestion and each condition is from different anatomical causes. First, if venous congestion was shown in whole flap, it is due to the connection between SIEV and vena comitantes of DIEP. Second, if venous congestion is limited in above midline (Hartrampf zone II), it is due to problem in venous midline crossover. In this article, the authors reviewed the role of SIEV in lower abdominal flap based on the various anatomic and clinical studies. The contents are mainly categorized into four main issues; basic anatomy of SIEV, the two cause of venous congestion, connection between SIEV and vena comitantes of DIEP, and midline crossover of SIEV.

Keywords

superficial inferior epigastric vein - venous congestion - deep inferior epigastric perforator flap - transverse rectus abdominis musculocutaneous flap

Author Contributions

Conception and design: S.O.P. and H.C. Acquisition of data: S.O.P., N.I., and H.C. Analysis and interpretation of data: S.O.P., N.I. and H.C. Writing or revision of the manuscript: S.O.P. and H.C. Final approval: all authors.


Ethical Approval

This study was approved by the Keio University School of Medicine Ethics Committee (approval no. 20070026).




Publication History

Article published online:
30 July 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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