Plastic Surgery, Policlinico di Sant'Orsola-DIMES, University of Bologna, Italy.
Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy.
J Reconstr Microsurg. 2021 Mar;37(3):216-226. doi: 10.1055/s-0040-1716349. Epub 2020 Sep 1.
Venous congestion is the most common perfusion-related complication of deep inferior epigastric artery perforator (DIEP) flap. Several hydraulic constructs can be created for venous superdrainage in case of flap venous engorgement or as a preventive measure. These can be classified based on the choice of the draining vein of the flap, either a second deep inferior epigastric vein (DIEV) or a superficial inferior epigastric vein (SIEV), and of the recipient vein, either a vein of the chest or the DIEV.
We conducted a comprehensive systematic literature review in Medline, Scopus, EMBASE, Cochrane Library, and Google Scholar to find publications that reported on venous congestion in DIEP flap. The keywords used were DIEP Flap, breast reconstruction, venous congestion, supercharging, superdrainage, SIEV, and DIEV.
Based on the studies found in the literature, we developed an algorithm to guide the surgeon's decision when choosing the veins for the superdrainage anastomosis.
Several alternatives for venous anastomosis in superdrainage are available. We propose an algorithm to simplify the choice. The use of the ipsilateral SIEV to be connected to a vein of the chest appears to be advantageous. The anatomical position that allows the easiest anastomosis dictates which chest vein to favor.
静脉淤血是深部腹壁下动脉穿支（DIEP）皮瓣最常见的与灌注相关的并发症。在出现皮瓣静脉淤血或作为预防措施的情况下，可以创建几种液压结构以实现静脉超引流。这些可以根据皮瓣引流静脉（即第二支深部腹壁下静脉[DIEV]或浅表腹壁下静脉[SIEV]）和接受静脉（即胸部静脉或 DIEV）的选择进行分类。
我们在 Medline、Scopus、EMBASE、Cochrane 图书馆和 Google Scholar 中进行了全面的系统文献综述，以查找报告 DIEP 皮瓣静脉淤血的出版物。使用的关键词是 DIEP 皮瓣、乳房重建、静脉淤血、增压、超引流、SIEV 和 DIEV。
根据文献中发现的研究，我们制定了一个算法，以指导外科医生在选择超引流吻合静脉时做出决策。
有几种静脉吻合的选择用于超引流。我们提出了一个简化选择的算法。将同侧 SIEV 连接到胸部静脉似乎是有利的。允许进行最容易吻合的解剖位置决定了要选择哪个胸部静脉。
