Benoit Ayestaray1, Kairi Yonekura, Hisashi Motomura, Makram Ziade. 1. From the *Department of Plastic and Reconstructive Surgery, Sud Francilien Hospital, University Paris, Evry, France; †Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka City University, Abeno-ku, Osaka, Japan; and ‡Department of Plastic and Reconstructive Surgery, Montpellier University Hospital, Montpellier, France.
Abstract
BACKGROUND: Nowadays, microvascular breast reconstruction with abdominal perforator flap is a popular and widespread technique. However, venous congestion is a recurrent problem in deep inferior epigastric artery perforator (DIEP) flap survival. We present a venous supercharging technique using the thoracoacromial vein in DIEP free flap for breast reconstruction. METHODS: A prospective randomized study was conducted in 52 patients undergoing a free DIEP flap breast reconstruction. Classical DIEP flap using 1 venous anastomosis (DIEP group) was compared with thoracoacromial venous supercharged DIEP flap using the ipsilateral superficial epigastric vein as a supercharging vein (DIEP-TAsc group). The endpoint was to assess the equivalence or the superiority of each technique. Statistical analysis was made with the t test and the χ test. RESULTS:Venous congestion occurred in 16 (55.1%) patients in the DIEP group, and 3 (13%) patients in the DIEP-TAsc group (P = 0.001). The venous congestion rate was 36.5%. Fat necrosis was experienced by 14 (48.2%) patients in the DIEP group, and 4 (17.4%) patients in the DIEP-TAsc group (P = 0.020). The fat necrosis rate was 34.6%. Partial flap necrosis occurred in 13 (44.8%) patients in the DIEP group, and 2 (8.7%) patients in the DIEP-TAsc group (P = 0.004). The partial flap necrosis rate was 28.8%. Total flap necrosis occurred in 5 (17.2%) patients in the DIEP group, but no (0%) patient in the DIEP-TAsc group (P = 0.036). The total flap necrosis rate was 9.6%. The mean operative time was 405 minutes (range, 355-460) in the DIEP group, and 510 minutes (range, 405-590) in the DIEP-TAsc group (P < 0.001). CONCLUSIONS: Thoracoacromial venous supercharging using the ipsilateral superficial inferior epigastric vein is a valuable method which considerably secures the DIEP free flap in breast reconstruction although it lengthens the operative procedure. EBM level: Level III.
RCT Entities:
BACKGROUND: Nowadays, microvascular breast reconstruction with abdominal perforator flap is a popular and widespread technique. However, venous congestion is a recurrent problem in deep inferior epigastric artery perforator (DIEP) flap survival. We present a venous supercharging technique using the thoracoacromial vein in DIEP free flap for breast reconstruction. METHODS: A prospective randomized study was conducted in 52 patients undergoing a free DIEP flap breast reconstruction. Classical DIEP flap using 1 venous anastomosis (DIEP group) was compared with thoracoacromial venous supercharged DIEP flap using the ipsilateral superficial epigastric vein as a supercharging vein (DIEP-TAsc group). The endpoint was to assess the equivalence or the superiority of each technique. Statistical analysis was made with the t test and the χ test. RESULTS:Venous congestion occurred in 16 (55.1%) patients in the DIEP group, and 3 (13%) patients in the DIEP-TAsc group (P = 0.001). The venous congestion rate was 36.5%. Fat necrosis was experienced by 14 (48.2%) patients in the DIEP group, and 4 (17.4%) patients in the DIEP-TAsc group (P = 0.020). The fat necrosis rate was 34.6%. Partial flap necrosis occurred in 13 (44.8%) patients in the DIEP group, and 2 (8.7%) patients in the DIEP-TAsc group (P = 0.004). The partial flap necrosis rate was 28.8%. Total flap necrosis occurred in 5 (17.2%) patients in the DIEP group, but no (0%) patient in the DIEP-TAsc group (P = 0.036). The total flap necrosis rate was 9.6%. The mean operative time was 405 minutes (range, 355-460) in the DIEP group, and 510 minutes (range, 405-590) in the DIEP-TAsc group (P < 0.001). CONCLUSIONS: Thoracoacromial venous supercharging using the ipsilateral superficial inferior epigastric vein is a valuable method which considerably secures the DIEP free flap in breast reconstruction although it lengthens the operative procedure. EBM level: Level III.