A quantitative analysis of the venous outflow of the deep inferior epigastric flap (DIEP) based on the perforator veins and the efficiency of superficial inferior epigastric vein (SIEV) supercharging

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 66; no. 1; pp. 67 - 72
• Main Authors: Rothenberger, Jens, Amr, Amro, Schiefer, Jennifer, Schaller, Hans-Eberhard, Rahmanian-Schwarz, Afshin
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.01.2013; Elsevier
• Subjects: Abdominal Wall - blood supply; Abdominal Wall - surgery; Adult; Biological and medical sciences; Breast reconstruction; Deep inferior epigastric artery perforator; DIEP; Epigastric Arteries; Female; Graft Survival; Hemoglobins - metabolism; Humans; Hyperemia - blood; Mammaplasty; Medical sciences; Middle Aged; Perforator Flap - blood supply; Perforator Flap - transplantation; Plastic Surgery; Regional Blood Flow; SIEV; Statistics, Nonparametric; Superficial inferior epigastric vein; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Venous drainage; DIEP; SIEV; Venous drainage; Superficial inferior epigastric vein; Deep inferior epigastric artery perforator; Breast reconstruction; perforator; Artery; Plasty; Treatment; Bypass; Efficiency; Surgery; Deep inferior epigastric artery; Breast; Flap (surgery); Rectus abdominis muscle; Quantitative analysis; Superficial vein
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2012.08.020

Summary Background While the arterial perfusion of the anterior abdominal wall has been extensively described in the literature, little has been published on the venous drainage of the deep inferior epigastric flap (DIEP). The present study was performed to further clarify the venous drainage of DIEP flap, which remains a common vascular complication of this flap. Methods We assessed the efficiency of venous outflow on 19 patients undergoing DIEP flap breast reconstruction, determining relative haemoglobin concentration (rHB) as an indicator of venous congestion. After the flap had been isolated on the perforator vessels, a selective clamping and declamping of the single lateral and medial perforator was performed and several measurements were carried out using a micro-lightguide spectrophotometer device (O2C: Oxygen to See; LEA Medizintechnik, Gießen, Germany). In addition, the efficacy of venous supercharging with ipsilateral and contralateral superficial inferior epigastric veins (SIEVs) was quantified. Results For the sake of simplicity, we applied the classic perfusion zones of the lower abdomen as suggested by Hartrampf (1983). Regardless of lateral or medial DIEP perforator veins, zone IV showed the least venous outflow, while we observed the highest drainage in zone I. There was no significant difference between the venous drainage of the two immediately adjacent zones II and III. Supercharging with the contralateral SIEV showed a significantly better venous drainage in the contralateral zones II and IV, whereas the ipsilateral SIEV did not present any significant improvement in the venous drainage of any zone. Conclusion This study evaluated the characteristics of the venous outflow of the DIEP flap, based on the single perforator and the SIEVs. Our findings revealed that zones II and III have a similar venous drainage regardless of the perforator veins used. The supercharging of the contralateral SIEV leads to an improved venous outflow compared to the ipsilateral SIEV. This may support surgeons in minimising venous complications and may improve the degree of DIEP flap survival.