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
