A systematic review of the scientific evidence of venous supercharging in autologous breast reconstruction with abdominally based flaps

Abstract

Background Abdominally based free flaps are commonly used in breast reconstruction. A frequent complication is venous congestion, which might contribute to around 40% of flap failures. One way to deal with it is venous supercharging. The primary aim of this study was to investigate the scientific evidence for the effects of venous supercharging. Methods A systematic literature search was conducted in PubMed, CINAHL, Embase, and Cochrane library. The included articles were critically appraised, and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results Thirty-six studies were included. Most studies had serious study limitations and problems with directness. Three studies report ‘routine’ use of venous supercharging and performed it prophylactically in patients who did not have clinical signs of venous congestion. Seventeen studies report on flap complications, of which one is a randomised controlled trial demonstrating statistically significant lower complication rates in the intervention group. The overall certainty of evidence for the effect of a venous supercharging on flap complications, length of hospital stay and operative time, in patients without clinical signs of venous congestion, is very low (GRADE ⊕ ⊕ ⊝ ⊝), and low on and surgical takebacks (GRADE ⊕ ⊕ ⊝ ⊝). Twenty-one studies presented data on strategies and overall certainty of evidence for using radiological findings, preoperative measurements, and clinical risk factors to make decisions on venous supercharging is very low (GRADE ⊕ ⊝ ⊝ ⊝). Conclusion There is little scientific evidence for how to predict in which cases, without clinical signs of venous congestion, venous supercharging should be performed. The complication rate might be lower in patients in which a prophylactic venous anastomosis has been performed. Trial registration PROSPERO (CRD42022353591).

Prophylactic Venous Supercharging in Deep Inferior Epigastric Artery Perforator Flap Surgery: A Retrospective Dual-Center Study

“…[1], [2], [3] In order to reduce the incidence of vascular compromise, many efforts including different supercharging (also called superdrainage) techniques have been done to attempt to augment the venous drainage of congested flaps and increase flap survival. [4], [5] Signs of venous congestion, including bluish-purplish changes in flap color, draining blood with brisk capillary refill, or bleeding, may already be evident intraoperatively, thus managed by performing a second venous route of drainage. The supercharging venous drainage has been done traditionally by using the other, generally smaller DIEV, not yet utilized for the first venous anastomosis, or the superficial inferior epigastric vein (SIEV).…”