Venous superdrainage in deep inferior epigastric perforator flap breast reconstruction

Venous congestion in DIEP flaps occurs infrequently but is most likely to happen in cases where there are very small perforators or where comitant veins of the perforators are injured during very delicate dissection. In the past 3 years, we used DIEP flaps for 37 breast reconstructions in 34 mastectomy patients (three bilateral cases); venous congestion occured in three of the flaps (8.1 percent). In these cases, venous superdrainage was established using the superficial venous system for additional drainage to the flap's pedicle, after which all flaps survived without further complication. Therefore, preserving and dissecting the superficial epigastric vein far interiorly during DIEP flap elevation will provide the length necessary for additional vein anastomosis, if it is later needed to save a congested flap.