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J Reconstr Microsurg 2021; 37(03): 216-226
DOI: 10.1055/s-0040-1716349
Original Article

Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature

Marco Pignatti 
1   Plastic Surgery, Policlinico di Sant'Orsola–DIMES, University of Bologna, Italy
,
Valentina Pinto
2   Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy
,
Federico A. Giorgini
2   Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy
3   Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
,
Maria Elisa Lozano Miralles
2   Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy
3   Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
,
Salvatore D'Arpa
4   Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
,
Riccardo Cipriani
2   Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy
,
Giorgio De Santis
3   Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Abstract

Background Venous congestion is the most common perfusion-related complication of deep inferior epigastric artery perforator (DIEP) flap. Several hydraulic constructs can be created for venous superdrainage in case of flap venous engorgement or as a preventive measure. These can be classified based on the choice of the draining vein of the flap, either a second deep inferior epigastric vein (DIEV) or a superficial inferior epigastric vein (SIEV), and of the recipient vein, either a vein of the chest or the DIEV.

Methods We conducted a comprehensive systematic literature review in Medline, Scopus, EMBASE, Cochrane Library, and Google Scholar to find publications that reported on venous congestion in DIEP flap. The keywords used were DIEP Flap, breast reconstruction, venous congestion, supercharging, superdrainage, SIEV, and DIEV.

Results Based on the studies found in the literature, we developed an algorithm to guide the surgeon's decision when choosing the veins for the superdrainage anastomosis.

Conclusion Several alternatives for venous anastomosis in superdrainage are available. We propose an algorithm to simplify the choice. The use of the ipsilateral SIEV to be connected to a vein of the chest appears to be advantageous. The anatomical position that allows the easiest anastomosis dictates which chest vein to favor.

Keywords

DIEP flap - superdrainage - algorithm - review


Publication History

Received: 10 May 2020

Accepted: 26 July 2020

Article published online:
01 September 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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