Abstract
Background Flap congestion is a frequently described intraoperative complication during autologous
breast reconstruction with abdominal perforator flaps, which, if not addressed, can
lead to detrimental results such as flap failure. Here, we describe our institution's
algorithm of intraoperative salvage of congested flaps and present their outcomes.
Patients and Methods All patient charts from 2002 to 2016 of a single plastic surgeon were reviewed for
patients who underwent deep inferior epigastric perforator flap breast reconstruction
resulting in 602 patients and 831 flaps. Of those, 38 women (6.3%) with 40 congested
flaps (4.8%) were included in this study. Based on the algorithm guiding the selection
of additional venous anastomosis, the patients' surgical details, outcomes, as well
as their demographic characteristics are evaluated.
Results Average age and body mass index of our cohort were 47.0 ± 8.0 years and 26.1 ± 3.9,
respectively. Ten patients (26.3%) were current or former smokers while 20 (52.6%)
required external radiation. Thirty-two congested flaps (80.0%) were predominantly
salvaged with a superficial inferior epigastric vein (SIEV)-to-deep inferior epigastric
vein (comitante) anastomosis. An SIEV-to-internal mammary vein comitante anastomosis
was the second favorite option (5 flaps, 12.5%). Five patients suffered minor complications
within a mean follow-up of 18.8 ± 12.3 months without flap failure, bleeding, or infection.
Conclusions Venous flap congestion is an uncommon intraoperative intricacy during free tissue
transfer for autologous breast reconstruction. Our proposed algorithm primarily recommends
adding an additional venous anastomosis between the superficial and deep drainage
system and results and favorable outcomes without major complications.
Keywords
venous congestion - anastomosis - free tissue transfer - breast reconstruction
