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The Impact Of Augmented Venous Drainage On Outcomes After DIEP Flap Reconstruction
Jacquelyn A. Knox, MD, Aileen Gozali, MM, Serena Bhaskerrao, BS, Daniel Soroudi, BS, Scott Hansen, MD, Merisa Piper, MD;
University of California, San Francisco, San Francisco, CA, USA
PURPOSE: Deep inferior epigastric perforator (DIEP) flaps carry risks of venous congestion, fat necrosis and flap necrosis, all of which significantly impact patients. While studies show venous supercharging with a superficial vein may reduce these risks, the impact of various supercharging techniques and other forms of augmented venous drainage have not been as well studied.
METHODS: We retrospectively reviewed all patients who underwent post-mastectomy DIEP reconstruction between 2004-2022 with at least 6 months follow-up. Clinical outcomes were compared between flaps with 1) a single standard venous anastomosis, 2) supercharging, defined as having one superficial and one deep venous anastomosis, and 3) two deep venous anastomoses.
RESULTS: We identified 473 standard flaps (311 patients), 62 supercharged flaps (36 patients), and 28 two deep vein flaps (17 patients) (Figure 1). Prior abdominal surgery was highest in the supercharged group (supercharged: 95%, two deep veins: 65%, standard: 63%, p= 0.01). Complications, including vascular takebacks, infection and flap loss were similar between groups. When controlling for BMI, radiation exposure, and abdominal surgical history, the rate of fat necrosis was significantly lower in the two deep veins group (two deep veins: 0%, supercharged: 17%, standard: 18%, p=0.03).
CONCLUSIONS: Several techniques for augmented venous drainage can be used with similar complication rates as a single venous anastomosis. Additional deep venous anastomoses may offer protection against fat necrosis.
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