Microvascular complications of DIEP flaps

Area of Science:

• Microsurgery
• Plastic Surgery
• Breast Reconstruction

Background:

• Deep inferior epigastric perforator (DIEP) flap is a preferred method for breast reconstruction due to lower donor-site morbidity.
• Reduced perforator count in DIEP flaps can increase the risk of vascular compromise.
• Venous congestion may occur even with a patent primary venous anastomosis.

Purpose of the Study:

• To evaluate vascular problems and outcomes in 100 consecutive DIEP flaps for breast reconstruction.
• To identify the incidence and management of venous congestion in DIEP flaps.
• To assess the efficacy of secondary venous bypass in managing DIEP flap venous congestion.

Main Methods:

• Prospective study of 100 consecutive DIEP flaps used in breast reconstruction.
• Monitoring for arterial and venous compromise, including congestion.
• Documentation of interventions, such as venous bypass, and flap outcomes.

Main Results:

• 99 out of 100 flaps were successful, with no arterial compromise.
• Venous congestion occurred in 15 flaps (15%).
• Five flaps required a secondary venous bypass (superficial epigastric vein to chest wall vein) for additional drainage; one flap was lost due to unmanaged venous outflow, and one experienced fat necrosis from bypass thrombosis.

Conclusions:

• Deep inferior epigastric perforator (DIEP) flap venous congestion occurs in 5% of cases despite patent primary anastomosis.
• A secondary venous bypass between the superficial epigastric vein and a chest wall vein is an effective management strategy.
• Failure to recognize and manage venous congestion can lead to flap loss.