Venous perforators in DIEAP flaps: an observational anatomical study using duplex ultrasonography

Area of Science:

• Plastic Surgery
• Vascular Anatomy
• Breast Reconstruction

Background:

• Deep inferior epigastric artery (DIEAP) flaps are popular for breast reconstruction.
• Venous congestion remains a complication due to less predictable venous drainage.
• Understanding DIEAP flap venous anatomy is crucial for improving outcomes.

Purpose of the Study:

• To investigate the anatomical distribution and diameters of arterial and venous perforators in DIEAP flaps.
• To analyze the relationship between arterial and venous perforators and their source vessels.
• To evaluate the clinical benefits of pre-operative assessment of DIEAP flap venous perforators.

Main Methods:

• Prospective study of 140 patients undergoing DIEAP flap breast reconstruction.
• Pre-operative Duplex ultrasonography to assess perforator location, diameter, DIEA, DIEV, and SIEV.
• Statistical analysis including t-tests and Pearson's correlation coefficients.

Main Results:

• 702 arterial and 355 venous perforators identified; 6.5% of patients lacked venous perforators.
• Venous perforators were larger on the right side (p=0.031).
• Identifying a medium/large venous perforator first yielded a 93.5% chance of finding an associated medium/large arterial perforator.

Conclusions:

• No correlation exists between perforator vein/DIEV size and SIEV size.
• Pre-operative identification of medium/large venous perforators improves the chances of finding suitable perforator complexes.
• Pre-operative venous perforator evaluation offers significant potential clinical benefits for DIEAP flap breast reconstruction.