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The Influence of a Pfannenstiel Scar on Venous Anatomy of the Lower Abdominal Wall and Implications for Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Kim, So Young M.D.; Lee, Kyeong-Tae M.D.; Mun, Goo-Hyun M.D., Ph.D.

Plastic & Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 540–548
doi: 10.1097/PRS.0000000000003107
Breast: Original Articles

Background: A Pfannenstiel incision involves the obstruction of superficial venous pathways and functional diversion of flow through alternative pathways and adjacent vessels. This study investigated the effect of a prior Pfannenstiel incision on venous anatomy of the lower abdominal wall; specifically, the superficial inferior epigastric vein (SIEV), using computed tomographic angiography.

Methods: A case-control study was performed of 50 patients with Pfannenstiel scars and 50 age-matched, body mass index–matched control patients without Pfannenstiel scars. The authors compared the number of direct/indirect and total communications between the SIEV and deep inferior epigastric artery perforator (DIEP) venae comitantes, midline crossover, and other SIEV-related anatomical changes by using computed tomographic angiography. Flap-related clinical outcomes and donor-site–related complications were also assessed.

Result: The median number of direct and total communications between the SIEV and DIEP venae comitantes in the study group was greater than in the control group. The percentage of SIEVs having more than two branching patterns per hemiabdomen was significantly higher in the study group than in the control group. The study group also showed a significantly lower rate of fat necrosis compared with the control group (p = 0.03). The rate of donor-site seroma was significantly higher in the study group.

Conclusion: This study suggests that the presence of a Pfannenstiel scar may promote the development of direct and total communications between the SIEV and DIEP venae comitantes and branching within the SIEV in the lower abdominal wall, which may facilitate venous drainage of adipose tissue in DIEP flap breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Seoul, Republic of Korea

From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.

Received for publication May 6, 2016; accepted August 31, 2016.

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

Goo-Hyun Mun, M.D., Ph.D., Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea, supramicro@gmail.com

©2017American Society of Plastic Surgeons