The Low DIEP Flap

Eom, Jin Sup; Kim, Do Yeon; Kim, Eun Key; Lee, Taik Jong

doi:10.1097/prs.0000000000001867

Cited by 28 publications

(6 citation statements)

References 16 publications

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“…Actually, Eom et al reported low DIEP of which upper border was 6 cm below the umbilicus showed significantly higher venous congestion rate than conventional DIEP flap (0% vs. 30.4%, p = 0.007). 18…”

Section: Connection Between Siev and Vc-diepmentioning

confidence: 99%

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap

2022

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In lower abdominal flap representing transverse rectus abdominis musculocutaneous (TRAM) flap or deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric vein (SIEV) exists as superficial and independent venous system from deep system. The superficial venous drainage is dominant despite a dominant deep arterial supply in anterior abdominal wall. As TRAM or DIEP flaps began to be widely used for breast reconstruction, venous congestion issue has been arisen. Many clinical series in regard to venous congestion despite patent microvascular anastomosis site were reported. Venous congestion could be divided in two conditions by the area of venous congestion and each condition is from different anatomical causes. First, if venous congestion was shown in whole flap, it is due to the connection between SIEV and vena comitantes of DIEP. Second, if venous congestion is limited in above midline (Hartrampf zone II), it is due to problem in venous midline crossover. In this article, the authors reviewed the role of SIEV in lower abdominal flap based on the various anatomic and clinical studies. The contents are mainly categorized into four main issues; basic anatomy of SIEV, the two cause of venous congestion, connection between SIEV and vena comitantes of DIEP, and midline crossover of SIEV.

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Section: Connection Between Siev and Vc-diepmentioning

confidence: 99%

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap

2022

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“…Lowering the flap could be helpful for closing the donor site. However, clinical results of low DIEP flap are not favorable; low DIEP flaps show a relatively high rate of venous congestion [17]. Although not all conditions matched perfectly in that clinical study, inclusion of only the suprapubic area could not solve the venous drainage problem.…”

Section: Plos Onementioning

confidence: 69%

Differences of the midline-crossing venous drainage pattern in supraumbilical and infraumbilical regions: Angiographic study using fresh cadavers

2020

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Current clinical and anatomical studies show that the venous problem associated with the deep inferior epigastric perforator flap results from poor midline-crossing. We examined the venous anatomy of the infraumbilical midline area and the dynamic venous flow of the deep inferior epigastric perforator flap in nine fresh cadavers. All nine abdominal specimens were harvested between the subcostal margin and the groin crease. Two specimens were used to analyze the abdominal venous anatomy, one of which was divided into two hemi-abdominal specimens. The remaining seven specimens were harvested as deep inferior epigastric perforator flaps with one major paraumbilical perforator. Venous cannulation and serial angiographic agent injection were performed in several conditions. Each specimen was radiographed using a soft X-ray system. For additional information, computed tomography (CT) angiography-visualized superficial inferior epigastric veins (SIEVs) and the supraumbilical branch were analyzed. We noted that the venous drainage between the bilateral SIEVs was easier to configure in the supraumbilical area than in the infraumbilical area. Only one to two short polygonal venous networks connect the bilateral superficial inferior epigastric veins in the supraumbilical area; however, long and multiple polygonal venous networks connect the bilateral superficial inferior epigastric veins in the infraumbilical area, which could be a predisposing factor for venous congestion. The mean distance from the umbilicus upper border to evident supraumbilical midline crossover was 18.39±4.03 mm (range: 10.10–28.49) in CT angiograms. In cadaver specimens, the mean distance was 10.87±4.85 mm (range: 4.6–18.9). Supraumbilical midline crossover was more favorable than infraumbilical midline crossover in venous flow.

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“… 18 The low DIEP can be used to reconstruct moderately sized breasts if reliable perforators exist below the umbilicus, offering the advantage of a low scar close to the pubic rim and obviating the need for umbilical detachment. 19 In case of insufficient abdominal tissue, a hybrid approach may be used, combining a pre-pectoral silicone gel implant with a DIEP flap. 20 The SIEA flap allows autologous breast reconstruction without violating the rectus fascia.…”

Section: Resultsmentioning

confidence: 99%

Trends and Innovations in Autologous Breast Reconstruction

Speck

Grufman²,

Farhadi

2023

Arch Plast Surg

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More than 40 years have passed since the description of the first “free abdominoplasty flap” for breast reconstruction by Holmström. In the meantime, surgical advances and technological innovations have resulted in the widespread adoption of autologous breast reconstruction to recreate the female breast after mastectomy. While concepts and techniques are continuing to evolve, maintaining an overview is challenging. This article provides a review of current trends and recent innovations in autologous breast reconstruction.

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The Low DIEP Flap

Abstract: Therapeutic, III.

Cited by 28 publications

References 16 publications

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap

Differences of the midline-crossing venous drainage pattern in supraumbilical and infraumbilical regions: Angiographic study using fresh cadavers

Trends and Innovations in Autologous Breast Reconstruction

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