Relationship between venous congestion and intraflap venous anatomy in DIEP flaps using contrast-enhanced magnetic resonance angiography.
BACKGROUND
Deep inferior epigastric artery perforator (DIEP) flap harvest is associated with a significant rate of venous congestion; however, the reason for this has not yet been fully explained. Contrast-enhanced magnetic resonance angiography enables detailed evaluation of both the arterial and venous anatomies.


METHODS
A retrospective review of DIEP flaps that underwent preoperative contrast-enhanced magnetic resonance angiography was performed. Outcomes were compared with preoperative radiologic reporting of contrast-enhanced magnetic resonance angiographic imaging, and anatomical data from the scans were also analyzed.


RESULTS
Review of 54 DIEP flaps with venous system reporting was performed. Seven DIEP flaps suffered venous congestion, all of which were raised on perforators without direct connections between the venae comitantes and the main arborization of the superficial inferior epigastric vein. In the 47 DIEP flaps without venous congestion, 46 were raised on at least one perforator with a direct venous connection between the perforator venae comitantes and the main arborizations of the superficial inferior epigastric vein. There was an extremely significant association between the absence of a direct connection with the perforator venae comitantes on magnetic resonance angiography and the occurrence of venous congestion (p < 0.0001). Sixty-eight percent of all perforators had direct venous connections, which were significantly more likely to be located in the medial row.


CONCLUSIONS
DIEP flaps elevated on perforators with venae comitantes with direct venous connections to the main arborization of the superficial inferior epigastric vein are significantly associated with a very low incidence of flap venous congestion. Contrast-enhanced magnetic resonance angiography allows detailed appraisal of the venous anatomy, which may minimize the risk of DIEP flap venous insufficiency and the need for salvage procedures.
Schaverien
Mark V
MV
Nottingham, United Kingdom From the Departments of Plastic Surgery and Radiology, Nottingham University Hospitals NHS Trust.
Ludman
Catherine N
CN
Neil-Dwyer
Jason
J
Perks
A Graeme B
AGB
Raurell
Anna
A
Rasheed
Tuabin
T
McCulley
Stephen J
SJ
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003287:Contrast Media; D019074:Epigastric Arteries / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008833:Microcirculation; D008875:Middle Aged; D016011:Normal Distribution; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011859:Radiography; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D003287:Contrast Media