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Microvascular Lifeboats: A Stepwise Approach to Intraoperative Venous Congestion in DIEP Flap Breast Reconstruction

Galanis, Charles M.D.; Nguyen, Phuong M.D.; Koh, Justin B.A.; Roostaeian, Jason M.D.; Festekjian, Jaco M.D.; Crisera, Christopher M.D.

Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0000000000000271
Breast: Special Topic
Abstract

Summary: The deep inferior epigastric perforator (DIEP) flap is becoming a widely practiced method of autologous breast reconstruction. Although it has been shown to be a safe and reliable technique with acceptable morbidity, disadvantages include a comparatively higher incidence of venous congestion and total flap loss compared with autologous reconstruction with a pedicled or free transverse rectus abdominis myocutaneous flap. Venous congestion is reported in up to one-third of cases of breast reconstruction with a DIEP flap. If venous congestion is detected and addressed intraoperatively compared with postoperatively, outcomes are significantly improved. A wide variety of techniques have been introduced to augment venous drainage to treat congestion and prevent flap failure. Here, the authors offer a comprehensive review of techniques available to address intraoperative venous congestion in DIEP flaps for breast reconstruction. From this review, the authors propose a stepwise, algorithmic approach to diagnosing and treating this potentially devastating complication.

Author Information

Los Angeles, Calif.; and Dallas, Texas

From the Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Ronald Reagan Medical Center; and the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication June 14, 2013; accepted January 21, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Charles Galanis, M.D., Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Ronald Reagan Medical Center, 200 Medical Plaza, Suite 465, Los Angeles, Calif. 90095, charlesgalanis@gmail.com

©2014American Society of Plastic Surgeons