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J Reconstr Microsurg 2018; 34(06): 404-412
DOI: 10.1055/s-0038-1626695
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Algorithmic Approach for Intraoperative Salvage of Venous Congestion in DIEP Flaps

Erica L. Bartlett
1   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
,
Dmitry Zavlin
2   Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
,
Zachery K. Menn
2   Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
,
Aldona J. Spiegel
2   Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
› Author Affiliations
Further Information

Publication History

06 September 2017

14 December 2017

Publication Date:
16 February 2018 (online)

Also available atMedOne
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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

Presentation

Parts of this manuscript were presented at the annual meeting of the Texas Society of Plastic Surgeons taking place in Ft. Worth, Texas (September 15–17, 2017).


Ethical Considerations

The work described in this manuscript was approved by our institutional review board (Protocol number Pro00011704: “Observational Research in the Department of Plastic and Reconstructive Surgery”). The authors adhered to the Declaration of Helsinki at all times.


Letter to this article:

Anterograde Flow Rerouting in Venous Supercharged DIEP FlapJ Reconstr Microsurg 2018; 34(06): e5-e5
DOI: 10.1055/s-0039-1700557