title: Microvascular lifeboats: a stepwise approach to intraoperative venous congestion in DIEP flap breast reconstruction.
abstract: The deep inferior epigastric perforator (DIEP) flap is becoming a widely practiced method of autologous breast reconstruction. Although it has been shown to be a safe and reliable technique with acceptable morbidity, disadvantages include a comparatively higher incidence of venous congestion and total flap loss compared with autologous reconstruction with a pedicled or free transverse rectus abdominis myocutaneous flap. Venous congestion is reported in up to one-third of cases of breast reconstruction with a DIEP flap. If venous congestion is detected and addressed intraoperatively compared with postoperatively, outcomes are significantly improved. A wide variety of techniques have been introduced to augment venous drainage to treat congestion and prevent flap failure. Here, the authors offer a comprehensive review of techniques available to address intraoperative venous congestion in DIEP flaps for breast reconstruction. From this review, the authors propose a stepwise, algorithmic approach to diagnosing and treating this potentially devastating complication.
authors.affiliation: Los Angeles, Calif.; and Dallas, Texas From the Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Ronald Reagan Medical Center; and the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Charles
authors.initials: C
authors.lastname: Galanis
authors.forename: Phuong
authors.initials: P
authors.lastname: Nguyen
authors.forename: Justin
authors.initials: J
authors.lastname: Koh
authors.forename: Jason
authors.initials: J
authors.lastname: Roostaeian
authors.forename: Jaco
authors.initials: J
authors.lastname: Festekjian
authors.forename: Christopher
authors.initials: C
authors.lastname: Crisera
mesh_terms: D000465:Algorithms; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000517:prevention & control*; D016462:Mammaplasty / Q000379:methods*; D055806:Microvessels; D061525:Perforator Flap / Q000098:blood supply*