Prophylactic Superdrained Deep Inferior Epigastric Perforator Flap: Systematic Review of Survival and Morbidity

The deep inferior epigastric perforator (DIEP) flap is considered the gold standard option for autologous tissue reconstruction after total mastectomy. To minimize complication rates, such as venous congestion, adding a second venous anastomosis to support the flap (venous superdrainage) has gained popularity, although the degree of clinical benefit remains unclear. This study presents a systematic review to evaluate the complication profiles of dual venous anastomosis DIEP flap breast reconstruction.

A systematic search of PubMed, Embase, and MEDLINE was performed to identify studies evaluating venous superdrainage in DIEP flap breast reconstruction. Seventeen studies were included, comprising 2964 flaps (1536 single-vein and 1428 dual-vein). Postoperative complications were extracted and reported descriptively, with direct comparisons highlighted when available.

Across 17 studies, including 2964 DIEP flaps, dual-venous anastomosis was associated with lower rates of venous-related complications. In the dual-vein group, complication rates were low, including venous congestion (0%-13%), venous thrombosis (0%-2.7%), total flap loss (0%-8.7%), fat necrosis (0%-17.4%), and partial flap loss (0%-13.3%). In contrast, single-vein cohorts demonstrated higher rates of key complications, particularly venous congestion (2.6%-55.1%), venous thrombosis (1.8%-18.8%), fat necrosis (4.9%-48.2%), partial flap loss (up to 44.8%), and total flap loss (up to 17.2%). Hematoma and infection rates were comparable between groups.

Optimizing clinical outcomes after DIEP flap breast reconstruction remains an important clinical goal. These results suggest that prophylactic supercharging of the DIEP flap with 2 veins may be associated with lower complication rates in several comparative studies.