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Double Venous System Drainage in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Single-Surgeon Experience

Boutros, Sean G. M.D.

Plastic and Reconstructive Surgery: April 2013 - Volume 131 - Issue 4 - p 671–676
doi: 10.1097/PRS.0b013e31828189e6
Breast: Original Articles
Video Discussion

Background: Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap has many advantages. The main drawback is the technical difficulty and risk of failure. Many flap failures are the result of venous insufficiency. The author explored the routine use of double venous system anastomosis in DIEP flap breast reconstruction.

Methods: In all consecutive DIEP flaps performed by the author from June 1, 2008, to July 1, 2012, in which it was technically feasible, a superficial vein was dissected and anastomosed to either an internal mammary perforating vein or a second vena comitans. Patient charts were reviewed for flap failure or return to the operating room for exploration of suspected vascular insufficiency. A standard chi-square test and Yates corrected chi-square test were used for analysis.

Results: Three hundred fifty-two DIEP flaps were performed on 192 patients in the study period. In 311 of 352 flaps (88.4 percent), double venous system anastomosis was possible. There were no flap failures in either group. In the double venous system group, there was one (0.3 percent) return to the operating room for venous congestion. In the single venous system group, there were two (4.9 percent). Chi-square analysis showed statistically significant reduction in operative explorations in the double venous system group (value of 8.9; p = 0.0029). A Yates correction, applied because of the low number of reoperations in both groups, also showed a statistically significant reduction (value of 4.3; p = 0.038).

Conclusion: Double venous system anastomosis statistically reduced operative take-backs in this study.

Houston, Texas

From the Houston Plastic and Craniofacial Surgery; Westside Surgical Hospital; and the Department of Surgery, Division of Plastic Surgery, University of Texas School of Medicine.

Received for publication July 16, 2012; accepted September 24, 2012.

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

Sean G. Boutros, M.D.; Houston Plastic and Craniofacial Surgery, 6400 Fannin Street, Suite 2290, Houston, Texas 77030,

©2013American Society of Plastic Surgeons