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Size of the Superficial Inferior Epigastric Vein as a Predictor for Use in Deep Inferior Epigastric Artery Perforator Flaps
Jennifer Pasko, Jason Cacioppo, M.D., Adam Cohen, M.D.
Indiana University Plastic Surgery
2010-03-30
Presenter: Jennifer Pasko
Affidavit:
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Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
The superficial inferior epigastric vein (SIEV) has been long recognized as an important potential conduit in deep inferior epigastric artery perforator (DIEP) flaps. Diffuse flap congestion, in spite of a patent deep inferior epigastric venous anastamosis, is an infrequent, but well described complication that occurs in approximately two percent of cases. The SIEV can serve as a vessel to augment venous outflow of such a flap and relieve the congestion. Although a poorly understood phenomenon, the likelihood of its use was thought to be directly proportional to the SIEV size and caliber. We aimed to investigate this assumption further. The in situ size of the SIEV was measured intra-operatively, as well as radiographically, as well as pre-operatively, in a CT angiogram of the abdomen and pelvis. These sizes were then correlated with the operative use of the SIEV. Forty-one sequential flaps were assessed and five flaps required venous outflow augmentation with the SIEV. No correlation between SIEV size and use was noted. Other factors such as BMI, age, BMI:SIEV size ratio and perforator size and quality also failed to predict the SIEV use. Flap outcomes were reported. The authors therefore conclude that the likelihood of the SIEV cannot be predicted from its caliber. This contradicts previously held assumptions that larger caliber SIEVs were more likely to result in their use. Therefore, we recommend that the SIEV should be dissected and harvested as a first maneuver in raising every DIEP flap.
