title: Use of the retrograde limb of the internal mammary vein to avoid venous congestion in DIEP flap breast reconstruction: Further evidences of a reliable and time-sparing procedure.
abstract: OBJECTIVE
  Venous congestion is a common cause of DIEP flap failure. When identified intraoperatively, an additional venous anastomosis can improve the venous outflow and prevent flap failure. The aim of this study was to assess if the retrograde limb of the internal mammary vein (IMV) could be considered a good recipient vessel to be used when persistent flap congestion is present, and a second venous anastomosis is required.
  
  
  METHODS
  A retrospective study was conducted in 74 patients who had undergone DIEP flap breast reconstruction. Patients were classified into two groups: SVA (single venous anastomosis) and DVA (dual venous anastomosis). In the SVA group (n = 38), the IMV antegrade limb was used for venous drainage. A single DIEV (Deep Inferior Epigastric Vein) was anastomosed to the superior arm of the IMV. In the DVA group (n = 36), both the antegrade (superior) and retrograde (inferior) stumps of the IMV were used, connecting the larger DIEV to the antegrade IMV and the other DIEV or the SIEV (Superficial Inferior Epigastric Vein) to the IMV retrograde limb.
  
  
  RESULTS
  No venous congestion or flap loss was observed when two venous anastomoses were performed using both the IMV antegrade and retrograde limbs (P = 0.3271). In the DVA group, no major complication occurred (P = 0.0453). Operative explorations were significantly reduced in the DVA group (P = 0.0242).
  
  
  CONCLUSIONS
  These findings suggest that when an additional venous outflow is required, the use of the IMV retrograde limb may help to avoid flap venous congestion. © 2016 Wiley Periodicals, Inc. Microsurgery 36:447-452, 2016.
authors.affiliation: Plastic Surgery Department, Henri Mondor Hospital, UPEC, Creteil, France. drsimonelapadula@gmail.com.
authors.forename: Simone
authors.initials: S
authors.lastname: La Padula
authors.affiliation: Plastic Surgery Department, Henri Mondor Hospital, UPEC, Creteil, France.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hersant
authors.affiliation: Plastic Surgery Department, Henri Mondor Hospital, UPEC, Creteil, France.
authors.forename: Warren
authors.initials: W
authors.lastname: Noel
authors.affiliation: Plastic Surgery Department, Henri Mondor Hospital, UPEC, Creteil, France.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Niddam
authors.affiliation: Plastic Surgery Department, Henri Mondor Hospital, UPEC, Creteil, France.
authors.forename: Oana
authors.initials: O
authors.lastname: Hermeziu
authors.affiliation: Plastic Surgery Department, Henri Mondor Hospital, UPEC, Creteil, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bouhassira
authors.affiliation: Plastic Surgery Department, Henri Mondor Hospital, UPEC, Creteil, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Bosc
authors.affiliation: Plastic Surgery Department, Henri Mondor Hospital, UPEC, Creteil, France.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Meningaud
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D019074:Epigastric Arteries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000517:prevention & control*; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D061525:Perforator Flap / Q000098:blood supply*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery*