Investigation of Routine Venous Augmentation in Deep Inferior Epigastric Artery Perforator Flap and Intraoperative...

Area of Science:

• Plastic Surgery
• Microsurgery
• Breast Reconstruction

Background:

• Limited data exists on the benefits of prophylactic venous augmentation in deep inferior epigastric perforator (DIEP) flaps.
• Assessing outcomes of single vein versus augmented vein DIEP flaps is crucial for optimizing surgical techniques.

Purpose of the Study:

• To evaluate the outcomes of single vein DIEP flaps compared to those with prophylactic venous augmentation.
• To introduce an intraoperative decision pathway for managing venous outflow in DIEP flaps.

Main Methods:

• Retrospective chart review of 1,099 patients undergoing DIEP flap breast reconstruction (2009-2023).
• Comparison of outcomes between single venous anastomosis and prophylactic multivenous anastomosis groups.
• Statistical analysis to determine significant differences in complication rates and operative times.

Main Results:

• No significant difference in the rate of return to the operating room for any cause or suspected venous compromise between groups.
• Suspected venous compromise occurred in 2.3% of flaps, with no difference between single vein and augmented vein groups.
• Prophylactic multivenous anastomosis was associated with significantly longer operative times (p < 0.001) without improving flap survival rates.

Conclusions:

• Prophylactic venous augmentation in DIEP flaps is not associated with improved postoperative outcomes or reduced flap loss.
• Routine multivenous anastomosis increases operative duration without clear benefit.
• An intraoperative decision pathway can help identify select DIEP flaps that may benefit from additional venous outflow, avoiding unnecessary augmentation.