The Superficial Vein-Only DIEP Flap.

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Deep inferior epigastric artery perforator (DIEP) flaps are standard for autologous breast reconstruction, relying on arterial inflow and venous outflow.
• Venous outflow is critical for DIEP flap success; the superficial inferior epigastric vein (SIEV) has been used to augment or salvage venous outflow.
• A variant, the superficial vein-only DIEP flap, uses the deep inferior epigastric artery and the SIEV for outflow.

Purpose of the Study:

• To describe a variant DIEP flap technique using only the superficial inferior epigastric vein (SIEV) for venous outflow.
• To evaluate the viability and outcomes of this superficial vein-only DIEP flap in autologous breast reconstruction.

Main Methods:

• Retrospective review of patients undergoing autologous breast reconstruction from July 2015 to March 2020.
• Identification of DIEP flaps exclusively using the SIEV for venous outflow, excluding salvage procedures.
• Analysis of patient and flap characteristics, complications, and harvest details.

Main Results:

• Thirty patients (35 flaps) were identified with superficial vein-only DIEP flaps.
• A complication rate of 26.7% was observed, with 62.5% of complications being minor and no flap loss.
• Complication rates were comparable to the standard DIEP flap population.

Conclusions:

• The superficial vein-only DIEP flap is a viable and reliable option for selected patients undergoing abdominally based breast reconstruction.
• This technique provides an additional tool to enhance the success of breast reconstruction.
• Consideration of the SIEV for superficial vein-only flaps should be part of routine DIEP flap reconstruction planning.