Abstract: Thin Patients are at Higher Risk for Venous Congestion During DIEP Reconstruction

Abstract

INTRODUCTION: Venous congestion occurs in 2–15% of deep inferior epigastric perforator (DIEP) flaps and often requires superficial inferior epigastric vein (SIEV) salvage.1,2 We previously showed thicker suprascarpal fat pads (>23 mm) are associated with increased SIEV caliber.3 We hypothesize that patients with thicker suprascarpal fat pads have a dominant superficial venous system and are more likely to suffer venous congestion. METHODS: An IRB-approved retrospective study was performed at New York-Presbyterian Hospital/Weill Cornell. Subjects included female patients who underwent unilateral or bilateral DIEP flap reconstruction from 2011- 2015. Radiographic measurements of suprascarpal fat pad thickness and SIEV diameter were collected per hemi-abdomen from pre-operative abdominal CT angiogram (CTA) imaging. Clinical outcomes recorded included: intra-operative venous congestion and SIEV usage. Statistical analysis explored if suprascarpal fat pad thickness was associated with clinical outcomes. RESULTS: 94 patients underwent 164 DIEP flaps. Mean suprascarpal fat pad thickness was 20.7mm ± 10.8 (4.9–65.4) and mean SIEV diameter was 2.8mm ± 0.7 (1.5–5.7). Five (3.0%) flaps exhibited venous congestion, with three (1.8%) requiring intra-operative SIEV salvage. All four cases of venous congestion in patients with pre-operative CTA occurred in flaps with suprascarpal fat pad thickness less than 18mm (p=0.041). CONCLUSIONS: There is a significantly increased risk of venous congestion with thinner suprascarpal fat pads (<18mm), suggesting that venous congestion is not related to superficial draining system dominance or increased SIEV caliber. We recommend SIEV dissection with suprascarpal fat pad thickness <18 mm. DISCLOSURE/FINANCIAL SUPPORT:None of the Authors has a financial interest in any of the products, devices or drugs mentioned in the manuscript. REFERENCES: 1. Sbitany H, Mirzabeigi MN, Kovach SJ, et al. Strategies for recognizing and managing intraoperative venous congestion in abdominally based autologous breast reconstruction. Plast Reconst Surg 129(4):809–815. 2012. 2. Granzow JW, Levine JL, Chiu ES, Allen RJ. Breast reconstruction with the deep inferior epigastric perforator flap: History and an update on current technique. Journal of Plastic, Reconstructive, and Aesthetic Surgery 59:571–579, 2006. 3. Bast J, Pitcher AA, Small K, Otterburn DM. Suprascarpal fat pad thickness may predict venous drainage patterns in abdominal wall flaps. Microsurgery 2016;36(2):99–103.