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Incidence of Patent Retrograde Flow Through Vena Comitans of the DIEP
Shayan M Sarrami, MD
Shayan Izaddoost, MD, PhD, FACS
Carolyn De La Cruz, MD
University of Pittsburgh
2024-01-15
Presenter: Shayan M. Sarrami
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. 100% of the work on this project is original work by the authors.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose
Venous congestion of the deep inferior epigastric perforator (DIEP) flap puts surgeons in a difficult situation that requires supercharging the superficial venous outflow. One popular solution is performing intra-flap anastomosis of the superficial inferior epigastric vein (SIEV) to the vena comitans (VC) of the DIEP. This restores proper venous outflow without requiring additional anastomosis to the thoracodorsal vessels, sacrificing the latissimus flap as a lifeboat. However, intra-flap anastomosis requires retrograde venous flow through the VCs. Communicating venous branches and weak valves may allow for reliable retrograde flow. Our study is the first to assess patent retrograde venous flow through the DIEP.
Methods
In patients receiving DIEP flap reconstruction, retrograde flow was tested using a heparin flush. Luminal diameter of each VC was recorded. Flow patterns were compared using Chi-Squared goodness-of-fit.
Results
Thirty-seven DIEP flaps from 20 patients were studied. Each DIEP showed patent VC connections, except for two that only contained a single VC. Of the remaining 35 flaps, the average luminal VC diameter was 2.38mm, commonly with one larger VC. Sixty-nine percent of perforators had communicative flow bidirectionally, between both VCs. Twenty-six percent had flow from the smaller VC to the larger, and 2 flaps had flow from the larger to the smaller VC (p=0.000).
Conclusion
Our results show intra-flap anastomosis, utilizing retrograde venous flow through the DIEP, is a reliable salvage pathway in congested flaps. While a majority of perforators showed bidirectional flow through the VCs, we found the smaller VC is a more dependable anastomotic option.
