An Algorithmic Approach to Dual-System Venous Drainage for DIEP Flap Breast Reconstruction

Area of Science:

• Plastic Surgery
• Microsurgery
• Breast Reconstruction

Background:

• Deep inferior epigastric perforator (DIEP) flap breast reconstruction is a common procedure.
• Limited comparative data exists on venous drainage strategies in DIEP flaps.
• Understanding optimal venous management is crucial for successful outcomes.

Purpose of the Study:

• To compare the outcomes of DIEP flap breast reconstruction using deep venous system alone versus dual-system venous drainage.
• To develop an algorithm to standardize the use of dual-system venous drainage in DIEP flaps.

Main Methods:

• Retrospective review of 244 DIEP flaps in 162 patients (March 2017-April 2021).
• Flaps categorized into deep venous system only (Group 1) or dual system (Group 2).
• Outcomes assessed: take-back to OR, flap loss, thrombosis, and operative time.

Main Results:

• No significant difference in take-back rates between groups (P=0.606).
• Flap loss rate was significantly lower in the dual-system group (0%) compared to the deep venous system only group (2.5%, P=0.031).
• Thrombosis rates were numerically higher in the deep venous system only group but not statistically significant (P=0.071).

Conclusions:

• Dual-system venous drainage significantly decreases flap loss in DIEP breast reconstruction.
• The proposed algorithm aids in flap design and vein selection for consistent dual-system venous drainage implementation.