An Algorithmic Approach to Dual-System Venous Drainage for DIEP Flap Breast Reconstruction

Abstract

Background: Few studies compared the use of the deep venous system alone versus combined superficial and deep venous drainage in DIEP flaps. The objective of this study is to compare DIEP flap breast reconstruction using either the deep venous system alone versus dual-system venous drainage and to propose an algorithm for flap design and orientation and veins selection to facilitate consistent use of dual-system venous drainage. Methods: Patients undergoing DIEP flap breast reconstruction between March 2017 and April 2021 were retrospectively reviewed. Flaps were divided into two groups: deep venous system only (Group 1) or dual-system (Group 2). Outcomes included takeback to the operating room (OR), flap loss and thrombosis and operative time. Results: A total of 244 DIEP flaps in 162 patients met inclusion criteria. A total of 130 flaps were included in Group 1 (53.3%) and 114 flaps were included in Group 2 (46.7%). Sixteen flaps (6.6%) required immediate takeback to the OR and takeback rates were not significantly different between groups (p=0.606). Flap loss rate was significantly higher in Group 1: 2.5% vs Group 2: 0%; p=0.031. Flap thrombosis occurred in 8 flaps (3.3%) and tended to occur more frequently in Group 1 but this finding did not reach significance (Group 1: 5.4% vs Group 2: 0.9%; p=0.071). Conclusions: The use of dual-system venous drainage in DIEP flap breast reconstruction decreases the rate of flap loss. Our algorithm can be used to guide selection of flap laterality, rotation, and veins and recipient vessels to facilitate routine use of dual-system venous drainage.