Skip to main content
SpringerLink
Log in

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

  • Chapter
Breast Reconstruction

  • 161 Accesses

Abstract

Breast reconstruction using the deep inferior epigastric perforator (DIEP) flap has many advantages when compared to other reconstructive methods with autologous tissue, namely reduced donor-site morbidity or manipulation of the soft tissue, positioning it as a preferred option in autologous breast reconstruction for many microsurgeons worldwide.

Venous congestion is regarded as one of the main concerns for microsurgeons during reconstruction with the DIEP flap, where complications secondary to venous drainage or venous anastomosis have been shown to be more common than problems concerning arterial anastomosis or insufficiency. The anastomosis between the superficial and deep venous system results in significant fewer operative take-backs, with a decreased incidence of venous complications when using the DIEP flap.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 259.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cronin TD, Gerow FJ (1963) Augmentation mammoplasty: a new “natural feel” prosthesis. Transactions of the Third International Congress of Plastic and Reconstructive Surgery, pp 41–49

    Google Scholar 

  2. Gill PS, Hunt JP, Guerra AB, Dellacroce FJ, Sullivan SK, Boraski J, Metzinger SE, Dupin CL, Allen RJ (2004) A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 113(4):1153–1160

    Article  PubMed  Google Scholar 

  3. Scheer AS, Novak CB, Neligan PC, Lipa JE (2006) Complications associated with breast reconstruction using a perforator flap compared with a free TRAM flap. Ann Plast Surg 56(4):355–358

    Article  PubMed  CAS  Google Scholar 

  4. Blondeel PN, Arnstein M, Verstraete K, Depuydt K, Van Landuyt KH, Monstrey SJ, Kroll SS (2000) Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 106(6):1295–1299

    Article  PubMed  CAS  Google Scholar 

  5. Nahabedian MY, Momen B, Galdino G, Manson PN (2002) Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg 110(2):466–475

    Article  PubMed  Google Scholar 

  6. Chen CM, Halvorson EG, Disa JJ, McCarthy C, Hu QY, Pusic AL, Cordeiro PG, Mehrara BJ (2007) Immediate postoperative complications in DIEP versus free/muscle-sparing TRAM flaps. Plast Reconstr Surg 120(6):1477–1482

    Article  PubMed  CAS  Google Scholar 

  7. Tran NV, Buchel EW, Convery PA (2007) Microvascular complications of DIEP flaps. Plast Reconstr Surg 119(5):1397–1405

    Article  PubMed  CAS  Google Scholar 

  8. Enajat M, Rozen WM, Whitaker IS, Smit JM, Acosta R (2010) A single center comparison of one versus two venous anastomoses in 564 consecutive DIEP flaps: investigating the effect on venous congestion and flap survival. Microsurgery 30(3):185–191

    Article  PubMed  Google Scholar 

  9. Kroll SS (2000) Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 106(3):576–583

    Article  PubMed  CAS  Google Scholar 

  10. Schaverien M, Saint-Cyr M, Arbique G, Brown SA (2008) Arterial and venous anatomies of the deep inferior epigastric perforator and superficial inferior epigastric artery flaps. Plast Reconstr Surg 121(6):1909–1919

    Article  PubMed  CAS  Google Scholar 

  11. Xin Q, Luan J, Mu H, Mu L (2012) Augmentation of venous drainage in deep inferior epigastric perforator flap breast reconstruction: efficacy and advancement. J Reconstr Microsurg 28(5):313–318

    Article  PubMed  Google Scholar 

  12. Sbitany H, Mirzabeigi MN, Kovach SJ, Wu LC, Serletti JM (2012) Strategies for recognizing and managing intraoperative venous congestion in abdominally based autologous breast reconstruction. Plast Reconstr Surg 129(4):809–815

    Article  PubMed  CAS  Google Scholar 

  13. Momeni A, Lee GK (2010) A case of intraoperative venous congestion of the entire DIEP-flap–a novel salvage technique and review of the literature. Microsurgery 30(6):443–446

    Article  PubMed  Google Scholar 

  14. Ali R, Bernier C, Lin YT, Ching WC, Rodriguez EP, Cardenas-Mejia A, Henry SL, Evans GR, Cheng MH (2010) Surgical strategies to salvage the venous compromised deep inferior epigastric perforator flap. Ann Plast Surg 65(4):398–406

    Article  PubMed  CAS  Google Scholar 

  15. Boutros SG (2013) Double venous system drainage in deep inferior epigastric perforator flap breast reconstruction: a single-surgeon experience. Plast Reconstr Surg 131(4):671–676

    Article  PubMed  CAS  Google Scholar 

  16. Carramenha e Costa MA, Carriquiry C, Vasconez LO, Grotting JC, Herrera RH, Windle BH (1987) An anatomic study of the venous drainage of the transverse rectus abdominis musculocutaneous flap. Plast Reconstr Surg 79(2):208–217

    Article  PubMed  Google Scholar 

  17. Schaverien MV, Ludman CN, Neil-Dwyer J, Perks AG, Raurell A, Rasheed T, McCulley SJ (2010) Relationship between venous congestion and intraflap venous anatomy in DIEP flaps using contrast-enhanced magnetic resonance angiography. Plast Reconstr Surg 126(2):385–392

    Article  PubMed  CAS  Google Scholar 

  18. Cohn AB, Walton RL (2006) Immediate autologous breast reconstruction using muscle-sparing TRAM flaps with superficial epigastric system turbocharging: a salvage option. J Reconstr Microsurg 22(3):153–156

    Article  PubMed  Google Scholar 

  19. Niranjan NS, Khandwala AR, Mackenzie DM (2001) Venous augmentation of the free TRAM flap. Br J Plast Surg 54(4):335–337

    Article  PubMed  CAS  Google Scholar 

  20. Tutor EG, Auba C, Benito A, Rábago G, Kreutler W (2002) Easy venous superdrainage in DIEP flap breast reconstruction through the intercostal branch. J Reconstr Microsurg 18(7):595–598

    Article  PubMed  Google Scholar 

  21. Kerr-Valentic MA, Gottlieb LJ, Agarwal JP (2009) The retrograde limb of the internal mammary vein: an additional outflow option in DIEP flap breast reconstruction. Plast Reconstr Surg 124(3):717–721

    Article  PubMed  CAS  Google Scholar 

  22. Wechselberger G, Schoeller T, Bauer T, Ninkovic M, Otto A, Ninkovic M (2001) Venous superdrainage in deep inferior epigastric perforator flap breast reconstruction. Plast Reconstr Surg 108(1):162–166

    Article  PubMed  CAS  Google Scholar 

  23. Guzzetti T, Thione A (2008) The basilic vein: an alternative drainage of DIEP flap in severe venous congestion. Microsurgery 28(7):555–558

    Article  PubMed  Google Scholar 

  24. Reardon CM, O’Ceallaigh S, O’Sullivan ST (2004) An anatomical study of the superficial inferior epigastric vessels in humans. Br J Plast Surg 57(6):515–519

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Houston Plastic Craniofacial and Sinus Surgery, 6400 Fannin, Suite 2290, Houston, TX, 77030, USA

    Sean G. Boutros M.D. & Carlos A. Martinez M.D.

Authors
  1. Sean G. Boutros M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos A. Martinez M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sean G. Boutros M.D. .

Editor information

Editors and Affiliations

  1. Tustin, California, USA

    Melvin A. Shiffman

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Boutros, S.G., Martinez, C.A. (2016). Double Venous System Drainage in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction. In: Shiffman, M. (eds) Breast Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-18726-6_80

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-18726-6_80

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18725-9

  • Online ISBN: 978-3-319-18726-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation