Easy Venous Superdrainage in DIEP Flap Breast Reconstruction Through the Intercostal Branch

Abstract

The deep inferior epigastric perforator (DIEP) flap has been shown to be a valid option for breast reconstruction, as it has certain advantages over the free TRAM flap, including lower morbidity in the donor area, conservation of abdominal wall function, and reduced postoperative pain. However, some cases of venous congestion in using the DIEP flap have been described. The authors present a case in which the venous return in a DIEP flap objectively (by measurement with a flux meter) presented a marked improvement (from 4 ml/min to 13.9 ml/min) after venous drainage was increased by means of the supplementary anastomosis of a comitant vein from the deep inferior epigastric pedicle to the intercostal branch of the internal mammary vein. The preservation of this branch is a simple and effective technique to improve the venous drainage of DIEP flaps, whether signs of congestion are present or not.

Reviewing the vascular supply of the anterior abdominal wall: Redefining anatomy for increasingly refined surgery

“…The suggestion has been that there is individual variability in the dominance of these venous systems. Reported methods for maximizing venous drainage in this setting has been to augment the venous drainage of congested flaps through additional venae comitantes of the ipsilateral DIEA (Marck et al, 1996;Tutor et al, 2002), through venae comitantes of the contralateral DIEA (Niranjan et al, 2001), through venae comitantes of the ipsilateral SIEA (Villafane et al, 1999;Blondeel et al, 2000;Wechselberger et al, 2001), and one study has suggested the use of the venae comitantes of the contralateral SIEA (Lundberg and Mark, 2006).…”

Deep Inferior Epigastric Perforator Flap Breast Reconstruction in a Patient with Huge Uterine Leiomyoma

“…To cope with this complication, superdrainage using the superficial epigastric vein has been proven effective [6][7][8][9][10][11]. We estimated the diameter of the vessel through MDCT preoperatively, and we preserved every perforator and pedicle, including all DIEAs, DIEVs, SIEVs, and superficial inferior epigastric arteries during dissection of the flap.…”

Double Venous System Drainage in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

“…Niranjan et al describe using a vein graft to connect the DIEV to the cephalic vein [18]. Another option described by Tutor et al involved connecting a venae comitantes of the DIEP pedicle to an intercostal branch of the IMV [19]. Additionally, with routine harvest of a superficial vein, the superficial venous system may be used for venous augmentation of the congested DIEP flap.…”