O111: SALVAGE: use of SuperficiAL inferior epigastric Vein (SIEV) for superdrainAge in deep inferior epiGastric pErforator (DIEP) flaps

Abstract

Abstract Introduction Deep inferior epigastric perforator (DIEP) flaps are established as the preferred flap for breast reconstruction. Venous congestion is the most common vascular complication that can lead to flap failure and fat necrosis. While limited studies have attempted to assess use of superdrainage using superficial inferior epigastric vein (SIEV) in DIEP flaps, they were inconclusive with small cohort sizes. Aims The primary aims of this study were to assess association between use of SIEV in DIEP flaps and reconstructive outcomes based on degree of venous congestion as well as number of graft failures, fat necrotic flaps and post-operative visits. The secondary aims were to analyse the intra-operative time to harvest SIEV and impact of costs to the NHS. Methodology 2154 patients undergoing DIEP flap reconstruction from March 2010 to June 2022 were restrospectively analyzed. Demographic data, chemo/radiotherapy status, and technique/flap details were procured. Outcome endpoints were evaluated based on occurrence of post-operative venous congestion, total and partial flap loss, fat necrosis, and operative time. Sub-set analysis of demographics was done to assess impact on outcomes. Results SIEV use was observed in 216 cases. Total flap loss was observed in 2.31% and partial flap loss in 6.48%. Fat necrosis was observed in 3.24% and post-operative venous congestion in 0.92%. Operative time was observed as 376 ± 48 minutes. Conclusion Although there was slightly increased operative time for SIEV harvest, superdrainage considerably reduced venous congestion, flap compromise, and related complications indicating improved overall cost to the NHS.