Novel use of the superficial inferior epigastric vein lifeboat in DIEP flap harvest

Abstract

Deep inferior epigastric artery perforator (DIEP) flap reconstruction has become a well-established procedure for breast reconstruction. While vascular compromise is not common, venous congestion is the most commonly reported cause of such compromise, and of those that may require re-exploration, insufficient venous drainage is the most common cause. In such cases, flap salvage may require establishment of a secondary venous outflow source. In a standard unilateral breast reconstruction with a DIEP flap, zone IV is discarded, with the intra-flap segment of the superficial inferior epigastric vein (SIEV) unused. We describe the novel approach of harvesting the SIEV within zone IV and banking within the breast pocket near the contralateral superficial vein should it be required for further salvage surgery. Our approach involves harvest of the SIEV on a side table (which allows simultaneous operating), flushing the graft with heparinized saline, and tagging the proximal end with an 8/0 nylon suture. This vein graft is then transferred and banked at the breast recipient site, near the flap vein where it is likely to be required. This simple step prevents further morbidity of a secondary donor site and reduces operative time should re-exploration be required.