title: Measuring the pressure in the superficial inferior epigastric vein to monitor for venous congestion in deep inferior epigastric artery perforator breast reconstructions: a pilot study.
abstract: During deep inferior epigastric artery perforator (DIEP) flap dissection, we noted that in many cases the superficial vein on the ipsilateral side of the flap was engorged and tense, and in others, it was empty. This led us to believe that the pressure is increased as the result of preferential outflow through the superficial vein in some cases, which could result in venous congestion of the flap if this vessel was not anastomosed. To test this hypothesis, we measured the venous pressure in the superficial venous system before and after flap dissection. The pressure in the superficial inferior epigastic vein of a DIEP flap was measured in 26 consecutive flaps to investigate the correlation between the pressure and venous congestion of the flap. The first measurement was performed at the beginning of the dissection, and the second measurement was taken after the flap had been completely raised on a single perforator. The mean increase in pressure after flap dissection was 10.6 mm Hg (mu = 10.6; range -1 to 31; O +/- 7.0 mm Hg). Clinical signs of venous congestion were observed in one case. In this case, the increase in venous pressure was with 31 mm Hg, also the highest. Although the results of this report are preliminary, they indicate that the pressure in the superficial vein of DIEP flaps might be of predictive value for venous congestion.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Jeroen M
authors.initials: JM
authors.lastname: Smit
authors.forename: Thorir
authors.initials: T
authors.lastname: Audolfsson
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
authors.forename: Paul M N
authors.initials: PM
authors.lastname: Werker
authors.forename: Rafael
authors.initials: R
authors.lastname: Acosta
authors.forename: Anders G
authors.initials: AG
authors.lastname: Liss
mesh_terms: D000328:Adult; D001795:Blood Pressure Determination / Q000295:instrumentation*; D019074:Epigastric Arteries; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis*; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014680:Veins