title: A Comparative Study Between Deep Inferior Epigastric Artery Perforator and Thoracoacromial Venous Supercharged Deep Inferior Epigastric Artery Perforator Flaps.
abstract: BACKGROUND
  Nowadays, microvascular breast reconstruction with abdominal perforator flap is a popular and widespread technique. However, venous congestion is a recurrent problem in deep inferior epigastric artery perforator (DIEP) flap survival. We present a venous supercharging technique using the thoracoacromial vein in DIEP free flap for breast reconstruction.
  
  
  METHODS
  A prospective randomized study was conducted in 52 patients undergoing a free DIEP flap breast reconstruction. Classical DIEP flap using 1 venous anastomosis (DIEP group) was compared with thoracoacromial venous supercharged DIEP flap using the ipsilateral superficial epigastric vein as a supercharging vein (DIEP-TAsc group). The endpoint was to assess the equivalence or the superiority of each technique. Statistical analysis was made with the t test and the χ test.
  
  
  RESULTS
  Venous congestion occurred in 16 (55.1%) patients in the DIEP group, and 3 (13%) patients in the DIEP-TAsc group (P = 0.001). The venous congestion rate was 36.5%. Fat necrosis was experienced by 14 (48.2%) patients in the DIEP group, and 4 (17.4%) patients in the DIEP-TAsc group (P = 0.020). The fat necrosis rate was 34.6%. Partial flap necrosis occurred in 13 (44.8%) patients in the DIEP group, and 2 (8.7%) patients in the DIEP-TAsc group (P = 0.004). The partial flap necrosis rate was 28.8%. Total flap necrosis occurred in 5 (17.2%) patients in the DIEP group, but no (0%) patient in the DIEP-TAsc group (P = 0.036). The total flap necrosis rate was 9.6%. The mean operative time was 405 minutes (range, 355-460) in the DIEP group, and 510 minutes (range, 405-590) in the DIEP-TAsc group (P < 0.001).
  
  
  CONCLUSIONS
  Thoracoacromial venous supercharging using the ipsilateral superficial inferior epigastric vein is a valuable method which considerably secures the DIEP free flap in breast reconstruction although it lengthens the operative procedure. EBM level: Level III.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Sud Francilien Hospital, University Paris, Evry, France; †Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka City University, Abeno-ku, Osaka, Japan; and ‡Department of Plastic and Reconstructive Surgery, Montpellier University Hospital, Montpellier, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Ayestaray
authors.forename: Kairi
authors.initials: K
authors.lastname: Yonekura
authors.forename: Hisashi
authors.initials: H
authors.lastname: Motomura
authors.forename: Makram
authors.initials: M
authors.lastname: Ziade
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D019074:Epigastric Arteries / Q000601:surgery / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006940:Hyperemia / Q000517:prevention & control / Q000601:surgery*; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation*; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology