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.
Plast Reconstr Surg. 2013 Apr;131(4):671-676. doi: 10.1097/PRS.0b013e31828189e6.
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.
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.
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).
Double venous system anastomosis statistically reduced operative take-backs in this study.
带深下腹上动脉穿支（DIEP）皮瓣的乳房再造有许多优点。主要缺点是技术难度大，失败风险高。许多皮瓣失败是静脉功能不全的结果。作者探讨了在 DIEP 皮瓣乳房再造中常规使用双静脉系统吻合术。
在作者于 2008 年 6 月 1 日至 2012 年 7 月 1 日期间进行的所有连续 DIEP 皮瓣中，如果技术可行，解剖并吻合一条浅静脉至内乳穿支静脉或第二伴行静脉。回顾患者病历，以了解皮瓣失败或因怀疑血管功能不全而返回手术室探查的情况。采用标准卡方检验和 Yates 校正卡方检验进行分析。
在研究期间，192 名患者中有 352 个 DIEP 皮瓣。在 352 个皮瓣中有 311 个（88.4%）可以进行双静脉系统吻合。两组均无皮瓣失败。在双静脉系统组中，有 1 例（0.3%）因静脉充血返回手术室。在单静脉系统组中，有 2 例（4.9%）。卡方分析显示，双静脉系统组手术探查次数明显减少（值为 8.9；p=0.0029）。由于两组再手术例数较低，应用 Yates 校正后也显示出统计学显著减少（值为 4.3；p=0.038）。
在这项研究中，双静脉系统吻合术在统计学上减少了手术返回率。
