title: Surgical strategies to salvage the venous compromised deep inferior epigastric perforator flap.
abstract: BACKGROUND
  Elevation of the deep inferior epigastric perforator (DIEP) flap interrupts its superficial venous system, and if drainage through the deep venous system is inadequate the flap may develop congestion. The purpose of this retrospective study was to determine the fate of the congested DIEP flap and to optimize the strategy for its salvage.
  
  
  METHODS
  Thirty-two of 162 patients who underwent unilateral breast reconstruction with a DIEP flap developed venous congestion. For the purpose of outcome analysis, cases were retrospectively allocated to "observation-only" (group A, n = 11), postoperative salvage (group B, n = 7), and intraoperative salvage (group C, n = 14), and complications among the various groups were compared to determine the necessity and optimal timing of salvage intervention.
  
  
  RESULTS
  Two flaps (1 in group A, another in group B) failed completely, giving a success rate 98.8%. The complication rate and hospital stay were significantly lower in group C than in group B (P = 0.03, P = 0.02). The rate of venous congestion requiring salvage procedures was 13%, with a salvage rate of 95%. Salvage procedures included venous augmentation with an additional recipient vein in 7 procedures, adding superficial inferior epigastric vein (SIEV) to DIEV in 11 procedures, and substituting with SIEV in 7 procedures. There was no statistical difference in flap salvage rate using the SIEV between "augmentation" and "substitution."
  
  
  CONCLUSIONS
  The salvage procedures for venous compromised DIEP flap are better performed intraoperatively rather than postoperatively to prevent further complications. The engorged SIEV could be incorporated by anastomosing to an additional recipient vein or adding to the DIEV-internal mammary vein axis or substituting for DIEV.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Rozina
authors.initials: R
authors.lastname: Ali
authors.forename: Christina
authors.initials: C
authors.lastname: Bernier
authors.forename: Yu Te
authors.initials: YT
authors.lastname: Lin
authors.forename: Wei-Cheng
authors.initials: WC
authors.lastname: Ching
authors.forename: Eduardo P
authors.initials: EP
authors.lastname: Rodriguez
authors.forename: Alexander
authors.initials: A
authors.lastname: Cardenas-Mejia
authors.forename: Steven L
authors.initials: SL
authors.lastname: Henry
authors.forename: Gregory R D
authors.initials: GR
authors.lastname: Evans
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000601:surgery; D016009:Chi-Square Distribution; D015331:Cohort Studies; D019074:Epigastric Arteries; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000601:surgery*; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D017568:Rectus Abdominis / Q000098:blood supply* / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods