Author(s): Galanis, Charles M.D.; Nguyen, Phuong M.D.; Koh, Justin B.A.; Roostaeian, Jason M.D.; Festekjian, Jaco M.D.; Crisera, Christopher M.D.

Summary: 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.


Plastic and Reconstructive Surgery: July 2014 - Volume 134 - Issue 1 - p 20–27 doi: 10.1097/PRS.0000000000000271

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